Advances in the diagnosis and management of esophageal cancer are highlighted in this review. Esophageal cancer, the seventh most common malignancy globally, is divided into two histological subtypes: esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC), which are biologically distinct. Despite advancements, outcomes remain poor due to late-stage diagnosis. Emerging strategies for early detection of precursor lesions, such as squamous dysplasia and Barrett's esophagus, offer potential for improved outcomes. Treatment options are evolving with the introduction of biologic agents and immune checkpoint inhibitors, enhancing systemic treatment for locally advanced and metastatic cases. Improvements in minimally invasive surgical and endoscopic techniques, along with precision radiotherapy technologies, further improve patient prognosis. EAC and ESCC have distinct epidemiological patterns, with ESCC more prevalent in certain regions and EAC in others. ESCC is linked with alcohol, tobacco, and environmental factors, while EAC is associated with obesity and GERD. The pathophysiology of these cancers involves somatic mutations and chromosomal instability, with ESCC developing from squamous dysplasia and EAC from Barrett's esophagus. Molecular studies reveal genomic differences, with ESCC showing high mutational burden and EAC showing chromosomal instability. The immune microenvironment plays a significant role in cancer progression, with ESCC showing an inflamed environment and EAC showing a more immunosuppressive environment. Genomic differences between EAC and ESCC include mutations in TP53, CDK2NA, and other genes, with ESCC showing higher mutational diversity. Barrett's esophagus is a precursor to EAC, and its progression involves changes in the microenvironment and genomic instability. Advances in early detection include the use of endoscopy, chromoendoscopy, and molecular assays. Prevention strategies include the use of proton pump inhibitors and non-steroidal anti-inflammatory drugs to reduce dysplastic progression. Early-stage esophageal cancer can be managed with endoscopic resection, while locally advanced disease may require neoadjuvant chemoradiotherapy or surgery. Personalized treatment approaches are being explored, with imaging, molecular, and immune tumor characteristics guiding treatment selection. Systemic treatments, including immune checkpoint inhibitors, are showing promise in improving outcomes. Radiation therapy is being optimized with concurrent chemotherapy and adaptive technologies, while proton beam therapy is being evaluated as an alternative to conventional radiotherapy. Surgical management includes various approaches, with minimally invasive techniques and enhanced recovery pathways improving outcomes. Overall, advances in diagnosis, treatment, and prevention are improving outcomes for patients with esophageal cancer.Advances in the diagnosis and management of esophageal cancer are highlighted in this review. Esophageal cancer, the seventh most common malignancy globally, is divided into two histological subtypes: esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC), which are biologically distinct. Despite advancements, outcomes remain poor due to late-stage diagnosis. Emerging strategies for early detection of precursor lesions, such as squamous dysplasia and Barrett's esophagus, offer potential for improved outcomes. Treatment options are evolving with the introduction of biologic agents and immune checkpoint inhibitors, enhancing systemic treatment for locally advanced and metastatic cases. Improvements in minimally invasive surgical and endoscopic techniques, along with precision radiotherapy technologies, further improve patient prognosis. EAC and ESCC have distinct epidemiological patterns, with ESCC more prevalent in certain regions and EAC in others. ESCC is linked with alcohol, tobacco, and environmental factors, while EAC is associated with obesity and GERD. The pathophysiology of these cancers involves somatic mutations and chromosomal instability, with ESCC developing from squamous dysplasia and EAC from Barrett's esophagus. Molecular studies reveal genomic differences, with ESCC showing high mutational burden and EAC showing chromosomal instability. The immune microenvironment plays a significant role in cancer progression, with ESCC showing an inflamed environment and EAC showing a more immunosuppressive environment. Genomic differences between EAC and ESCC include mutations in TP53, CDK2NA, and other genes, with ESCC showing higher mutational diversity. Barrett's esophagus is a precursor to EAC, and its progression involves changes in the microenvironment and genomic instability. Advances in early detection include the use of endoscopy, chromoendoscopy, and molecular assays. Prevention strategies include the use of proton pump inhibitors and non-steroidal anti-inflammatory drugs to reduce dysplastic progression. Early-stage esophageal cancer can be managed with endoscopic resection, while locally advanced disease may require neoadjuvant chemoradiotherapy or surgery. Personalized treatment approaches are being explored, with imaging, molecular, and immune tumor characteristics guiding treatment selection. Systemic treatments, including immune checkpoint inhibitors, are showing promise in improving outcomes. Radiation therapy is being optimized with concurrent chemotherapy and adaptive technologies, while proton beam therapy is being evaluated as an alternative to conventional radiotherapy. Surgical management includes various approaches, with minimally invasive techniques and enhanced recovery pathways improving outcomes. Overall, advances in diagnosis, treatment, and prevention are improving outcomes for patients with esophageal cancer.