Martins MCL, Miyazaki DL, Gabiatti CCT, et al. - Esophageal carcinoma develops in around 4% to 10% of patients diagnosed with Chagas-induced megaesophagus disease, so researchers assessed the natural history and clinical pattern of Chagas megaesophagus–associated carcinoma (CMAC). Among 593 patients with esophageal carcinoma treated at a single Brazilian institution, 32 patients with Chagas disease were identified, of whom 11 had megaesophagus. The three groups were similar in baseline features, however, a lower rate of smoking was reported among patients with CMAC, which reinforced the concept that for cancer development, achalasia is the principal risk factor. A median progression-free survival of 7.8 months and a median overall survival of 9.1 months was seen in patients with locally advanced CMAC. Findings emphasize prompt detection of CMAC in view of dismal prognosis if the tumor was not recognized in advance. This highlights the necessity for a high index of suspicion of esophageal carcinoma for patients with Chagasic megaesophagus.