I was genuinely saddened to read of the death of Keith Floyd this week who was suffering from bowel cancer. People such as him with a genuine love of a topic and the gift to be able to impart that enthusiasm to other people and so in turn enthuse them are few and far between, and the world is a poorer place for his passing.

This made me muse on my belief that the Americans have their cholesterol, the French their liver and the British – well, the British have their bowels.  This not only presents in what may politely be called our predilection for toilet humour but, if I enquire politely of patients as to how their bowels have been, then they usually feel satisfied that they have had a good consultation whatever else I may have said!  Despite this, one survey published by the Imperial Cancer Research Fund found that over half of people never checked to see if they had been bleeding before flushing the loo, and less than one in four people recognised the symptoms of bowel cancer.  Bowel cancer (also called colorectal cancer) remains the second biggest cause of cancer death in the UK and the third most common overall but it frustratingly remains one of the most readily treated if found early enough with some 90% of early bowel cancers being curable. There are some thirty thousand new cases every year and seventeen thousand people die annually from it with 95% of cases occurring in the over fifties and being more common in men.

There is a strong genetic element to this particular cancer and some 6 – 7 % of people with it have a family history of the disease.  If you gave a close relative such as a parent or sibling who has been diagnosed, under the age of 45, with bowel cancer then you yourself have a fourfold increased risk of developing it.

However, this risk is age related since, if you have the same close relative who is diagnosed after the age of 60, then your risk is the same as the rest of the general population.  Aside from genetics, our Western diet undoubtedly is the main player here.  A typical low fibre, high fat diet is believed to account for 80% of cases of bowel cancer in the Western world and so in essence this is why it can be such a preventable disease.

Other risk factors include an unhealthy, inactive lifestyle, or the existence of other bowel disorders such as Ulcerative Colitis or Crohn’s disease, which cause chronic inflammation of the bowel lining.

The main symptoms of colorectal cancer are a change in bowel habit compared to the usual, such as bouts of constipation or diarrhoea, rectal bleeding - is either blood mixed in with the motions or the motions are very dark, although it is something of a fallacy to assume that if rectal bleeding is bright red then it must always be from piles since, depending on where the cancer is, the blood can be bright red too – and abdominal pain or pain on opening the bowels. There may also be weight loss, poor appetite, tiredness and a feeling of never opening the bowels fully or wanting to go to the toilet again when you have just been.

However there are a number of harmless conditions which can also cause similar symptoms and so it does not mean you have bowel cancer if you have some of these. It simply means you need to get checked out.  At present, there is no automatic or generalised bowel-screening programme for bowel cancer in asymptomatic people but you should certainly be examined if you have any of the above symptoms or if the disease runs in your family.  Your doctor will take a general history, examine you abdominally and will also do a rectal examination with their finger and refer you to a specialist for further tests if appropriate. If bowel cancer is present then, if caught early enough, its cure rate is potentially great.  The caveat here, of course, is the phrase “if caught early enough”.  Eight out of ten people with bowel cancer have surgery but in half of these the cancer recurs because it has spread to other organs, especially the liver.

To give yourself the best chance of defending against this common cancer you should try to eat a diet low in fat and rich in fruit and vegetables, cut down on tea and coffee, eat plenty of high fibre cereals, pasta and wholemeal bread and keep your intake of red meat to a minimum as well as cutting back on fried foods, sweets, chocolates and cakes, Try to trim the fat off poultry and meat and stay as trim as you can yourself since obesity is a risk factor here. Because people who exercise through their lives run the lowest risk of colon cancer, try to stay active even if this is as simple as walking briskly every day. Get to know your bowel habits and what is normal for you. If these change let your doctor know – it might just save your life.