Nasal cavity as the first site of metastases from colorectal adenocarcinoma without metastases elsewhere is generally unheard of and very rare with only a few cases reported in world literature. The diagnostic dilemma and therapeutic challenge are significant when encountered in clinical practice, especially to differentiate it from a primary nasal pathology. Histopathological examination and immunohistochemistry play an important role. We report an unusual and interesting case of adenocarcinoma rectum with nasal metastases. A 65-year-old male was treated for adenocarcinoma rectum with radiotherapy, surgery and chemotherapy and was disease-free for 9 months post-treatment completion. Subsequently, he presented with nasal bleeding and on evaluation was found to have a nasal mass. Histopathological examination and immunohistochemistry confirmed the mass to be a metastasis from the earlier rectal adenocarcinoma. He received palliative haemostatic radiotherapy for bleeding from the nasal mass and was then treated with 6 cycles of 5-fluorouracil and irinotecan-based palliative chemotherapy. The patient achieved a good level of palliation, had near-complete regression of nasal mass on imaging with no new sites of metastases and hence was placed on regular follow up.