This case involves an elderly female patient with a long history of acid reflux who presented with difficulty swallowing. She was referred to an ENT who ordered a barium study for dysphagia. The study showed reflux but no abnormalities and the patient was prescribed Esomeprazole. After a few months on the medication with no improvement, the ENT recommended an esophagoscopy and direct laryngoscopy, which showed no evidence of a tumor. Following the procedures, the patient continued to have nausea episodes while eating. The patient decided to see a GI who recommended an esophagogastroduodenoscopy (EGD). The test showed severe obstruction and firm narrowing at the gastroesophageal junction. A biopsy was taken at this time and revealed esophageal carcinoma stage IV.