A 52-year-old man was found to have invasive carcinoma in a sessile polyp discovered on the anterior rectal wall 12cm from the anal verge during routine colonoscopy. The majority of the lesion was removed with the snare, and the site was injected with dye for intraoperative localization. Pre-operative workup showed no evidence of metastatic or nodal disease. The patient was taken to the operating room for anterior resection (as opposed to the historical posterior resection) of the rectum. The patient was positioned in extended lithotomy position.