The most important feature of esophageal cancer is the disruption and destruction of esophageal mucosa, which is a typical sign of early stage esophageal cancer. Other features include filling defect, niche shadow, soft tissue mass shadow, narrowing of esophageal lumen, stiffness and slow peristalsis of esophageal wall under fluoroscopy, etc. In clinical practice, we often find that some physicians only perform esophagogram spot film to diagnose esophageal cancer. Our experience is that spot film examination is not enough for the diagnosis of esophageal cancer, especially for small early esophageal cancer, which is often neglected. The diagnostic accuracy of upper gastrointestinal imaging is not only related to the scope of imaging, imaging technique, but also to the interpretation of imaging results, i.e., the diagnostic level of the radiologist. Compared with fiberoptic gastroscopy, upper gastrointestinal tract imaging is more useful for the diagnosis of larger typical esophageal cancers, but for smaller early esophageal cancers, its diagnostic rate is not satisfactory, only about 75%. Therefore, upper gastrointestinal angiography should be combined with fiberoptic gastroscopy for the diagnosis of esophageal cancer.