Bowel cancer: How to check your poo
Dame Deborah James, who has died from bowel cancer at the age of 40, told everyone to check their poo as part of her campaign to raise awareness of the disease.
We answer the questions that many are asking about one of the most common types of cancer in the UK.
How do I spot bowel cancer?
There are three main things to look out for:
blood in your poo that happens for no obvious reason - it may be bright red or dark red
a change in how you poo - such as going to the toilet more often or your poo becoming more runny or hard
feeling lower tummy pain or bloating, when your belly feels full and tight
There may be other symptoms too, such as:
you've lost weight
you feel you haven't emptied your bowel properly after a poo
you feel more tired or dizzy than usual
Having these symptoms doesn't necessarily mean it's bowel cancer, but advice is to see a GP if you notice them for three weeks or longer and if things just don't feel right.
That means they can be checked out quickly. The earlier cancers are diagnosed, the easier they are to treat.
Sometimes bowel cancer can stop waste passing through the bowel and this can cause a blockage. This can bring on severe tummy pain, constipation and sickness. You will need to see your GP or go to your nearest A&E straight away in those circumstances.
How do I check my poo?
Have a good look at what comes out when you go to the toilet and don't be embarrassed to talk about it.
You should be looking out for blood in your poo as well as bleeding from the bottom.
Bright red blood may come from swollen blood vessels (piles) in your back passage, but it could also be caused by bowel cancer.
Dark red or black blood in your poo may come from your bowel or stomach, and could also be worrying.
You may also be noticing a change in bowel habit, such as looser poo or pooing more often than normal.
Or you might feel you're not emptying the bowels properly and not going often enough.
Bowel Cancer UK recommends keeping a diary of symptoms before you visit your GP so you don't forget anything at your appointment.
Doctors are used to seeing lots of people with a variety of bowel problems, so tell them about any changes or bleeding so they can find out the cause.
What causes bowel cancer?
No-one is sure exactly what causes it, but there are some things which can make it more likely to develop:
the older you are, the more likely cancer becomes and bowel is no different - most cases are in adults over 50
eating a diet with lots of red meat and processed meat, such as sausages, bacon, salami
smoking cigarettes can up the risk of many cancers
drinking too much alcohol
being overweight or obese
having a history of polyps in your bowel which can grow into tumours
Does it pass down through families?
In most cases, bowel cancer isn't hereditary but you should tell your GP if you have any close relatives diagnosed before the age of 50.
Some genetic conditions, such as Lynch syndrome, mean people have a much greater risk of developing bowel cancer, but these can also be prevented if doctors know about the condition.
How to reduce your risk?
More than half of bowel cancers could be prevented by people following a healthier lifestyle, scientists say.
That means taking more exercise, eating more fibre and less fat, and drinking about six to eight glasses of water a day.
But it also means going to your GP with any concerning symptoms and taking up the offer of cancer screening as soon as it is offered.
Can I be tested?
Screening, run by the NHS, aims to detect bowel cancer at an early stage. It involves a home test kit, which looks for hidden blood in poo, being posted to you so you can complete it and send it back.
But it's not available to everyone - only to those age groups most likely to benefit.
Screening happens across the UK.
In England, the age you become eligible for screening is gradually being lowered from over 60 to people aged 50 and over.
In Scotland, screening starts from age 50.
In Wales, it's for people aged 58-74.
In Northern Ireland, it's for people over 60.
Screening isn't 100% accurate and can lead to harm and unnecessary treatment when lots of healthy people are tested.
So if you're in a younger age group and have symptoms, you should be aware of the symptoms and visit your GP if concerned - don't buy a self-test kit, because the results can be confusing.
How is bowel cancer diagnosed?
Once you've returned your home test kit, you'll either be given the all-clear or contacted by your local hospital for further tests.
These could be a colonoscopy - a procedure which uses a camera inside a long tube to look inside the whole bowel - or a flexible sigmoidoscopy, which looks at part of it.
More than 90% of people diagnosed with bowel cancer at its earliest stage will survive for five years or more - compared with 44% when diagnosed at the latest stage.
The chances of survival in the UK have more than doubled in the last 40 years - more than half of patients now survive for 10 years or more, compared with one in five in the 1970s.
Like many cancers, 15 to 40-year-olds have the highest survival rates, because cancer is more common and more deadly in older people.
However, in general, survival is still not as good in the UK as the rest of Europe.
What treatments are available?
Bowel cancer is curable, especially if diagnosed early.
Treatments are becoming more personalised, and advances in genetic testing mean care can be tailored to the way each individual deals with their body's own cancer.
This approach still needs refining, but it is promising extra years of life for those with cancer.
At whatever stage your cancer is spotted, you will be talked through the treatments available.
That might be surgery, or chemotherapy and radiotherapy, or one or the other depending on your individual cancer.
Bowel Cancer UK has advice on the best questions to ask at appointments with specialists.
What are the different stages of cancer?
Stage 1 cancers - are small, but haven't spread
Stage 2 cancers - are larger, but still haven't spread
Stage 3 cancers - have now spread to some of the surrounding tissue such as lymph nodes
Stage 4 cancers - have spread to another organ in the body, creating a secondary tumour
Source: Phillippa Roxby, Health reporter