One month history of rectal bleeding mixed with his stools. He denied any other alarm symptoms. His past surgical history was unremarkable and he took lithium on a regular basis for bipolar disorder. There was no strong family history of bowel cancer. This gentleman was an ex-smoker. Colonoscopy showed a rectal lesion which was biopsied. This showed a tubulovillous adenoma with high grade dysplasia and invasion (early T3 lesion).