The treatment paradigm of esophageal carcinoma is evolving as is the appreciation that histology drives treatment decisions. For adenocarcinoma, neoadjuvant chemotherapy followed by en bloc transthoracic resection is the gold standard of care. In this setting, the addition of radiotherapy does not seem to be associated with a survival benefit. For squamous cell carcinoma, neoadjuvant chemoradiotherapy is currently the best therapeutic option. However, modern neoadjuvant chemotherapy regimens may engender better survival outcomes for these patients too. Moreover, the role of immunomodulating therapies and selective surgical approaches are yet to be fully appreciated and may influence future recommendations.