When a malignant fistula develops between esophagus and trachea, the underlying cancer is invariably incurable whether the primary site is in the esophagus or in the trachea. The frequent complication of this fistula is nonresolving aspiration pneumonia, either from ingestion or from backward flow of gastric contents into the esophagus. Pulmonary sepsis causes fatality in about 6 to 12 weeks if aspiration through the fistula is not treated quickly. The fistula develops in untreated esophageal cancer in approximately 5% to 15% of cases, lung cancer in less than 1% of cases, and tracheal cancer in 14.75% of cases.