This case takes place in South Dakota and involves a 65-year-old female (adopted / family history unknown) who had breast cancer (triple negative, mastectomies and chemo). Three years after being diagnosed with breast cancer, she had mucus and blood in her stools, with intermittent left lower abdominal pain. Her PCP sent her to a colorectal surgeon, who had performed a colonoscopy on the patient 5 years prior to her cancer diagnosis, for a repeat colonoscopy. During this most recent visit, the colorectal surgeon performed an anoscopy and prescribed treatment for hemorrhoids with no further studies. The bleeding improved. A year later, she developed nausea and dizziness. Her PCP palpated an enlarged liver and ordered CT/biopsy of 4 liver tumors. It proved to be metastasis from colon cancer, not breast. CT and colonoscopy showed large descending colon tumor. Her stage 4 colon cancer is now considered terminal.