Conventional radiation fields for gynecologic malignancies include the primary tumor and regional lymph nodes in the pelvis. However, the mesorectum is not routinely assessed and usually is avoided to limit treatment related toxicities. There is a previous case report about mesorectal lymph node metastases (MRNM) in gynecologic cancers, but to the best of our knowledge there is no reported data evaluating the incidence of MRNM in this population. We would like to report our initial findings on MRNM incidence in cervical and vaginal cancer. A total of 31 patients sequentially evaluated for radiotherapy of cervical or vaginal cancer within the last year were reviewed. Three diagnostic radiologists retrospectively assessed all available pre-treatment imaging for positive nodal involvement in the pelvis, including the mesorectum. Pelvic nodal metastasis was defined as ≥ 1 cm, MRNM as ≥ 0.5 cm for CT and MRI scans. PET / CT scans generally were considered positive with SUV max > 2.5. The relationship of MRNM incidence with primary site, FIGO stage, other lymphatic involvement, and histology were evaluated. Of the 31 patients, 25 cervical (Stage IB2: 5; Stage II: 8; Stage III: 10; Stage IV: 2) and 6 vaginal (Stage I: 1; Stage II: 4; Stage III: 1) cases were evaluated. Eighteen pre-treatment PET/CT, 15 CT and 5 MRI scans were reviewed. Nineteen (61%) patients had positive pelvic nodal metastasis. Four of the 31 patients were positive for MRNM, which constitutes 12.9% of all the reviewed patients and 21% of patients with other pelvic nodal involvement. Of the patients with MRNM, two had cervical cancer (both stage III) and two had vaginal cancer (one stage II and one stage III). All patients with MRNM had squamous histology and had presence of pelvic node involvement. The incidence of MRNM was 12.9% of all reviewed patients and 21.0% of all patients with pelvic lymphatic involvement. More advanced disease and pelvic lymph node involvement are associated with MRNM. Further investigation is ongoing.