A 69-year-old hispanic male initially presented with abdominal pain, weight loss, and hematochezia. Patient was seen in gastroenterology clinic after 6-month having experienced lower abdominal pain, malaise, unintentional weight loss and loose bowel movement with occasional blood in the stool. Patient denied any similar symptoms prior to that time. Past medical history was positive for benign essential hypertension. Personal and family history were negative for colorectal cancer, inflammatory bowel disease or other gastrointestinal diseases. On physical examination, abdomen was soft, non-tender, with no palpable masses. Digital rectal examination revealed a palpable circumferential mass at approximately 7 cm from anal verge. Routine blood tests including complete blood count, comprehensive metabolic panel and urinalysis were all within normal limits, except hypochromic microcytic anemia with a hemoglobin of 7.4 g/dL and carcinoembryonic antigen was elevated to 4.1 ng/dL (normal range 0.0-3.0 ng/dL) Patient underwent a diagnostic colonoscopy which revealed a near-obstructing, circumferential, ulcerated rectal mass at 7 cm from anal verge. Magnetic resonance imaging of the pelvis was consistent with extramural invasion of the tumor into the muscularis propria with mesorectal nodal involvement.