CASE PRESENTATION: 61 year old male with medical history of esophageal reflux and 45 pack year smoking was admitted to the hospital with significant dysphagia. Vitals were all within normal limits. Physical examination was significant for absent lymphadenopathy, regular cardiac rate and rhythm, and intact neurological exam. Significant labs were hemoglobin of 11g, MCV of 74.9 and platelets of 424,000. Endoscopy showed extrinsic compression of proximal esophagus and biopsy showed esophageal squamous cell cancer. Staging computerized tomography showed three bilateral pulmonary nodules and mediastinal lymphadenopathy. EBUS of left Para tracheal lymph node showed squamous cell cancer which was CK56 positive, p63 positive, and TTF-1 negative. Esophageal cancer was staged as TxN1M0 (stage 3). Biopsy of the 1.9cm pleural based right upper lobe pulmonary nodule revealed adenocarcinoma which was TTF-1 positive. This was staged as T1a, Nx, Mx at diagnosis. Other solid lung nodules were sub-centimeter but FDG avid on PET scan. Lung carcinomas were treated as was treated as unknown stage because other nodules were not biopsied. Magnetic resonance imaging brain was negative for any metastatic disease. Molecular analysis was negative for EGFR, RAS, BRAF, ALK, MET, RET or ERBB2 mutations. He was initiated on concurrent chemo radiotherapy with carboplatin and paclitaxel to treat both esophageal and lung cancers.