Dame Deborah James, mother, podcaster and bowel cancer campaigner has died aged 40

Most significantly she has tackled the 'taboo on poo' and broken down barriers . Bowel cancer is one of the most treatable cancers if diagnosed early at stage 1. Sadly her diagnosis was made at the age of 35 at stage 4.

As patron of Bowel Cancer UK and on the podcast ' You, Me and the Big C' about life with and treatment of and other topics relating to the diseases cancer she has shared her story through surgery, chemotherapy and radiotherapy. She explored the best ways to die and made sure that she marked life's milestones. Her journey has been open, informative funny and emotional throughout. She has displayed 'rebellious hope' to the end.

She has successfully drawn attention to the five symptoms of bowel cancer;

Blood in your poo or from your bottom
Obvious change in bowel habit
Weight loss you can't explain
Extreme tiredness for no apparent reason
Lump and /or pain in your tummy

These tests can be done to detect Colorectal Cancer and, in general, this is how they are used in clinical practice

• Tests for occult blood in the stool - this type of test became more sensitive and more specific with the introduction of Faecal Immunological Testing (FIT) in early 2018 - a symptomatic patient is very unlikely to have Colorectal Cancer if the FIT test is negative - the vast majority of FIT tests are done in primary care

• Colonoscopy - this is the 'gold-standard' test and can detect even very small cancers - biopsies can be taken for cancer confirmation - small cancers within polyps can often be fully resected by Colonoscopy

• Barium enema was used for decades before Colonoscopy was established in the 1970s but now has an unacceptable false-negative rate and has been superseded by CT Pneumocolon for those patients in whom a total Colonoscopy cannot be achieved

• CT scanning - a standard CT scan will only detect a sizeable Colorectal Cancer - however, the technique of CT Pneumocolon (sometimes called virtual Colonsocopy when a CT scan is undertaken with the colon inflated with air, and then a 3D colonic image is reconstructed) can detect Colorectal Cancer and polyps down to 0.5cm in size (although biopsy is clearly not possible) - it is used in for those patients in whom a total Colonoscopy cannot be achieved and for frailer older patients who tolerate Colonoscopy less well

• Faecal Calprotectin - it has been noticed that a moderate elevation of Faecal Calprotectin can be detected in patients with Colorectal Cancer, but it is certainly not used a diagnostic test for Colorectal Cancer.

Dame James raised nearly 7,000,000 for bowel cancer causes. A truly remarkable woman that has left a lasting legacy urging others to check their symptoms. here are the final words on her Instagram account;

"find a life worth enjoying; take risks; love deeply, have no regrets; and always, always have rebellious hope. And finally, check your poo-it could just save your life" x

A shining example of a human on a personal and professional level.