Physical examination should include a thorough examination of the abdomen, including palpation for an enlarged liver or tumor mass. A digital rectal examination is essential for any patient who has had LAR or local excision because anastomotic recurrences may be palpable and the digital examination will provide information with regard to the size of the recurrence, its location relative to the upper part of the anorectal ring, and the degree of xation to the luminal wall. is information may indicate involvement of surrounding pel­vic structures. Endoscopy may help dene the proximal margin of the recurrence, the extent of the luminal involvement, and the over­all extent of disease. Examination of the groin and supraclavicular regions is required to exclude adenopathy. Assessment of neuromus­cular function in the lower extremities can identify decits resulting from peripheral nerve involvement by lateral tumor recurrence. In women, a bimanual pelvic examination may reveal disease involving the rectovaginal septum, vagina, uterus, and adnexal structures. e perineal region aer APR also should be closely examined to detect tenderness, a mass, or a sinus/stula. A pelvic examination in women aer APR facilitates the detection and extent of disease involvement. In patients with pelvic recurrence for whom radical surgery is being considered, a complete colonoscopy should be performed preopera­tively to rule out synchronous neoplasms.