Introduction: In December 2019, a novel virus emerged in China (COVID-19) affecting the way we practice medicine. Colorectal cancer screening and surveillance, via colonoscopy, had to be postponed in order to diminish risks of exposure. In this case we will illustrate the effects of delayed CRC screening, and how a lucky fall played a part in diagnosing our patient’s rectal cancer. Case Description/Methods: A 71-year-old man with history of chronic tobacco abuse, presented to the ER for evaluation after falling down a flight of stairs. On ROS, he denied any alarm symptoms, except for weakness. Physical examination identified a malnourished individual, with pain on his left arm. CT was remarkable for left humeral fracture and a left sided pulmonary mass. PET scan revealed two avid lesions, one consistent with a left lung mass and another at distal rectum (Figure 1, Panel A). Colonoscopy with EUS was done, results are seen in Figure 1, Panel B. Biopsy of rectal mass was consistent with rectal adenocarcinoma (Figure 1, Panel B, C). Lung mass biopsy revealed an adenocarcinoma whose primary origin was unknown. Tumor board discussions culminated with recommendations to repeat core needle biopsy of lung. Immunohistochemistry aided in his final diagnosis of stage IV CRC (Figure 1, Panel D,E). Treatment was supportive and he was discharged home. Discussion: Our patient is a prime example of how the pandemic has dramatically changed the way we practice medicine. Not having undergone a colonoscopy in his life, a fortuitous fall became the most vital symptom in his rectal cancer diagnosis. He did not have typical alarm symptoms, yet he presented with sarcopenia and gradual weakness. While minimizing risks of exposure, imaging was vital for our patient. Nontheless, EUS and core needle biopsy were ultimately needed to distinguish multiple primary tumors from stage IV rectal cancer. Amid the pandemic, short-course chemoradiotherapy and brachytherapy may be an acceptable treatment plan. Undoubtedly, the impact of COVID-19 on colorectal screening and surveillance has been great. This virus has seriously altered modern medical practice; however, maintaining our goal of protecting patients, we rose to the occasion.Figure 1.: A. Hypermetabolic process on the walls of the distal rectum. B. Large friable mass at rectum with perirectal tissue/prostate gland/anal canal infiltration. C, D. Rectal pathology: Superficially invasive, well differentiated adenocarcinoma. E,F. Lung pathology: Cytology consistent with adenocarcinoma, CDX-2 positive, Napsin-A negative.