Colorectal cancer (CRC) is the second leading cause of cancer death in the United States, second only to lung cancer. Rectal cancer accounts for approximately one-third of colorectal tumors. Rectal cancers differ from colonic carcinomas in terms of their embryologic origin, treatment, and sites of metastasis. The majority are adenocarcinomas, which arise from a background of adenomatous dysplasia. Risk factors include adenomatous polyposis syndromes, a personal or family history of sporadic CRCs or adenomatous polyps, and inflammatory conditions such as inflammatory bowel disease (especially ulcerative colitis). Patients often present with hematochezia, tenesmus, and narrowing of the stool. Anemia is uncommon at presentation.