Purpose: A 60-year-old white Hispanic man presented to the hospital with a 4-month history of dysphagia, odynophagia, and 30 pound weight loss. He initially had discomfort when swallowing solids, which progressed to softer foods. He also complained of post-prandial nausea and vomiting. He denied any fever, night sweats, hematochezia, melena or hematemesis. He noted a 40 pack-year history of tobacco smoking. His physical examination was significant for cachexia and lymphadenopathy. Firm lymph nodes were palpable in the left submandibular and left supraclavicular areas. Laboratory studies demonstrated a microcytic anemia (hemoglobin of 10.6 mg/dL and MCV of 74fL). Due to a complaint of epigastric abdominal pain in the emergency room, a computed tomogram (CT) of the chest and abdomen was done. It revealed a narrowing at the level of the mainstem bronchi with multiple mediastinal, hilar, retroperitoneal, periportal, retrocrural, and peri-pancreatic enlarged lymph nodes suspicious for lymphoma. The CT also showed a dilatation of the proximal esophagus with noted mass effect from an adjacent 3.6 x 6.0 cm subcarinal lymph node. No thickening of the esophageal or gastric walls was visualized. Bronchoscopic fine needle aspiration of a subcarinal lymph node was performed. The biopsy demonstrated cellular evidence of carcinoma with extensive necrosis. Immunohistochemistry was positive for keratin and negative for p63, suggesting squamous cell as the tissue of origin. Flow cytometry showed no evidence for lymphoma. Given the patient's ongoing dysphagia and microcytic anemia, an upper endoscopy was performed revealing a circumferential mass at 35cm from the incisors with a white appearance and heaped edges extending into the cardia of the stomach. Biopsy confirmed poorly differentiated adenocarcinoma of gastrointestinal tract origin with signet-ring features. This case demonstrates the importance of using the patient's chief complaint and history in guiding diagnostic testing. The patient's dysphagia, weight loss, and microcytic anemia supported the gastrointestinal tract as a source for the unifying diagnosis of adenocarcinoma of the esophagus or gastric cardia. The untimely CT scan resulted in a delay in diagnosis and other unnecessary invasive testing to disprove erroneous diagnoses of lymphoma and squamous cell cancer.