We are experiencing great advances in the medical field that help in early diagnosis of rectal cancer that tend to reduce the patient’s morbidity and mortality, instead early prognosis, screening protocols greatly improved the overall patient’s well-being. However it should always be taken into account that pathological biopsies have varying rates of specificity and sensitivity, therefore we should not only rely on pathological findings solely but patients clinical presentation still remains a gold standard for treatment setup. We can see from this case that we will not only depend on the preoperative biopsy pathological results, many cases with repeated multiple biopsies with benign lesions, however post resection pathology showed adenocarcinoma. Therefore, we should also depend on the clinical symptoms as well as on the scope finding indicating the ''L'' defined shape obstructing the lumen. In this case study, I will be presenting a case that was admitted and diagnosed in King Faisal Specialist Hospital and Research center that clearly revealed that biopsy does not always rule out malignancy. Keywords: Biopsy and Surgery, Colorectal Cancer, Rectal Cancer recurrence, Cancer and Surgery, Pathological findings and clinical presentation.