Rectal adenocarcinoma in pt3n2mx belongs to stage III or IV. Rectal adenocarcinoma accounts for the majority of all rectal cancers, and microscopically differentiated adenoid structures, a small number of neuroendocrine cells and Paneth cells can be seen. They are subdivided into tubular adenocarcinoma and papillary adenocarcinoma, the latter being less malignant. PT3N2Mx rectal adenocarcinoma is usually referred to as T3 (i.e., the tumor penetrates the intrinsic muscular layer to reach the subplasma layer or invades the pararectal tissues without peritoneal coverage), N2 (with 4 or more regional lymph node metastases), and Mx (distant metastases cannot be evaluated) according to the international TNM staging after pathological biopsy. Of these, N2 can be subdivided into N2a (with 4 to 6 regional lymph node metastases) and N2b (with 7 and more regional lymph node metastases).Mx can be subdivided into M0 (without distant metastases) and M1 (with distant metastases). Because no clear classification result is available, it can be roughly categorized as stage III or IV. Further examination such as MRI is recommended to clarify the diagnosis and interpret the pathologic results in conjunction with the clinician’s opinion.