This case concerns an 87-year-old female patient who presented with a several-month history of rectal bleeding (rectorrhagia) and a deterioration in general condition. Her symptoms were followed by the onset of a palpable mass in the anal region approximately one month ago. Given the persistence and nature of her symptoms, the patient sought consultation with a gastroenterologist. After a thorough evaluation, the gastroenterologist performed a colonoscopy, which revealed and ulcerating, fungating process in the lower rectum (Figure 4). The mass exhibited characteristics suggestive of malignancy, prompting the decision to perform biopsies from both the rectal lesion and the anal mass. The biopsy results confirmed the presence of rectal adenocarcinoma (Moderately differentiated) with metastatic spread to the anal region, a rare but clinically significant complication in the context of advanced rectal cancer. Given the diagnosis, the patient was referred for further imaging, specifically a rectal MRI, to assess the extent of disease and better understand the local spread. MRI shows a Circumferential wall thickening of the lower and mid-rectum, irregular in shape, showing intermediate signal on T2 (Figure 1), hypointense on T1, and hyperintense on diffusion (Figure 2), with a low ADC. The lesion shows heterogeneous enhancement after contrast injection (Figure 3), measuring a maximum thickness of 19 mm, extending over 62 mm, and located 46 mm from the anal margin, with the presence of a tumor deposit near the anus, showing the same signal characteristics as the previously described lesion; it is in contact with the inferior pole of the internal sphincter, showing heterogeneous enhancement after contrast injection, measuring 20 x 13 mm, suggesting an anal metastasis from the previously described rectal cancer.