We would normally insert a rectal gel to outline the lumen, but not in this case given the presence of an anal mass
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Locally advanced rectal cancer invading the mesorectal fat with local and distant lymph node metastases as well as probable extension into the vault of the vagina (on the left) and extension via the anal mucosa out to the right posterior anal verge. Restricted diffusion is seen in the tumour and the local as well as distant lymph nodes.