Carcinoma of the esophagus is a devastating disease associated with poor survival outcome and with adverse affects on swallowing and quality of life. Although esophageal cancer is an aggressive malignancy that usually presents in a locally advanced stage, significant progress has been made in the treatment of this disease, including expanded treatment options, decreased surgical morbidity and mortality, and improvements in identifying patients who are at risk. These advances are resulting in incremental improvements in outcome, but there remains considerable controversy over the optimal management under individual scenarios. The emphasis of this chapter is on selecting the appropriate options in the curative and palliative management of esophageal cancer.