Esophageal cancer is very popular in Hong Kong. The tumor is often prevalent in males and has a modal peak of occurrence in the 7th decade. The pathogenesis of the esophageal neoplasm is still uncertain but likely to be multi-factorial. The commonest histological subtype is squamous cell carcinoma. Besides, mucoepidermoid carcinoma/adenosquamous carcinoma, adenocarcinoma, small cell carcinoma, sarcomatoid carcinoma, adenoid cystic carcinoma, undifferentiated carcinoma, melanoma and gastrointestinal autonomic nerve tumor are also found in a minority of patients. The proportion of various histologic subtypes is different from the Western populations. Concerning the genetic alternation, P53 mutation is common in esophageal squamous cell carcinoma. Esophageal cancer has its unique pattern of P53 mutations in Hong Kong. In addition, intramural metastasis and multiple lesions are characteristic features in esophageal squamous cell carcinoma. Important pathologic factors in determining the prognosis of patients with esophageal cancer includes completeness of surgical resection, stages, tumor dimension as well as MIB-1 scores and the presence of P53 mutations.