A 51 year old female presented with a chief complaint of hematochezia, dyschezia, tenesmus and stool incontinence. She also reported a six month history of constipation and pencil thin stools. A colonoscopy demonstrated a near-circumferential friable and bulky rectal mass 4–5 cm from the anal verge (Fig. 1). Biopsy of the mass revealed a moderately differentiated adenocarcinoma presumed to be of rectal origin. Computed tomography was significant for regional lymphadenopathy without evidence of vaginal involvement.