T1 colorectal cancer & ECOPOP
T1 colorectal cancer is an early stage of disease in which the tumour has grown into the inner wall of the bowel but has not spread beyond it. At this stage, more than one treatment approach may be appropriate, and the right choice is not always obvious.
ECOPOP explores how treatment for early colorectal cancer can be better matched to the individual patient, reducing unnecessary surgical burden while maintaining safe and effective care.
What is T1 colorectal cancer?
T1 cancer means that the tumour has grown into the submucosal layer – just beneath the inner lining of the bowel – but there is no confirmed spread to lymph nodes or other organs. These cancers are increasingly found through bowel screening programmes, often at a stage where curative treatment is possible.
The central clinical question is whether cancer cells may have already reached nearby lymph nodes – a risk that varies considerably between patients, and that current tests cannot always determine with certainty.
Why treatment decisions are complex
Low risk in many patients
For a significant proportion of patients with T1 cancer, the risk of lymph node involvement is very low, and extensive treatment may not be necessary.
But not zero
In some patients, cancer has already spread beyond the primary tumour. This cannot always be ruled out based on initial findings alone.
Limited certainty before treatment
Current diagnostic tools cannot perfectly predict which patients require more extensive treatment. This is one of the key problems ECOPOP is designed to address.
Decisions with lasting consequences
The choice between surgery and endoscopic treatment may significantly affect recovery time, bowel function, and long-term quality of life.
Two treatment approaches
Endoscopic treatment
Removal of the tumour through the bowel using a flexible camera, which means no surgical incision.
- No large surgical wound
- Shorter recovery time
- Lower risk of procedure-related complications
- Does not remove or assess lymph nodes
Surgical treatment
Removal of a segment of bowel, including the surrounding lymph nodes.
- Removes lymph nodes, providing staging information
- More complete pathological assessment
- Greater physical burden and longer recovery
- Risk of complications, including long-term bowel dysfunction
Both approaches are established medical procedures used in clinical practice. The challenge lies in identifying the most appropriate option for each individual patient.
The clinical dilemma
Neither option is without risk, and choosing the wrong one has real consequences. This is why ECOPOP trials exist.
If surgery is avoided
Endoscopic treatment is less invasive, but it does not assess lymph nodes. In patients where cancer has already spread, this may result in undertreatment.
vs
If everyone is operated on
Surgery provides more complete information, but for patients with very low risk, the procedure may be unnecessary. This is overtreatment.
How ECOPOP addresses this challenge
ECOPOP is designed to generate evidence for identifying which patients may safely benefit from less invasive treatment and which require more extensive intervention.
Comparing treatment strategies
Endoscopic and surgical approaches are evaluated in controlled clinical trials.
Monitoring oncological safety
Cancer outcomes are closely tracked to ensure that reducing treatment intensity does not compromise effectiveness.
Measuring quality of life
The impact on recovery and daily functioning is treated as a key outcome.
Improving decision-making
The goal is to support more precise, patient-specific treatment decisions in the future.
What this may mean for patients
The aim of ECOPOP is not to promote one treatment over another, but to determine which option is safest and least burdensome for each patient.
The ECOPOP trials
ECOPOP includes three clinical trials for different situations in early colorectal cancer.
ETHOS
for selected patients with newly diagnosed early colon cancer
SCAR
for patients whose cancer was found after removal of a presumed polyp
T-REX
for selected patients with early rectal cancer after local tumour removal
Not sure if one of these trials may be relevant for you? You can discuss it with your doctor and show them the study description.