Colorectal cancer (CRC) is the fourth most common cancer in men and the third most common cancer in women worldwide. The recent decline of CRC in the USA has been attributed to successful development of screening programs. In the last 20 years, endorectal ultrasound (ERUS) has become the primary method for locoregional staging of rectal cancer. Transvaginal sonography (TVS), with a high-frequency probe, obtains excellent image resolution of deep pelvic organs. TVS not only enables diagnosis and treatment in gynecology, infertility, and early pregnancy but also has the potential to detect other structural abnormalities within its reach, such as neoplasm of the rectosigmoid. Three-dimensional power Doppler ultrasound (3D PD) can depict the morphology of the vessel tree of tumors, and thus help to discriminate between benign and malignant neoplasm. In this case of a 42-year-old patient, an adnexal mass was diagnosed by TVS. Three-dimensional ultrasound gave topographic evidence of sigmoid colon tumor. Spectral Doppler and 3D PD diagnostic criteria of tumor vasculature, demonstrated in this neoplasm, were highly suspicious of malignancy. TVS diagnosis initiated endoscopic histological verification of adenocarcinoma of the sigma and timely surgical intervention.