In a retrospective study we counted the number of neoplasias associated with oesophageal epidermoid cancer, as we thought that their frequency and influence on treatment had been underestimated. Between 1982 and 1990, 181 patients underwent surgery of oesophageal epidermoid cancer. The global actuarial 5-year survival rate was 20.7 percent (28.8 percent after complete excision of the tumour). The mean follow-up period was 4.2 +/- 2.6 years. These 181 patients had a total of 324 cancers, 97 percent of which were cancers of the upper respiratory and digestive tracts. The frequency of associated cancers was 56 percent (102 out of 181), and 50 percent of the patients presented with at least one associated head and neck cancer. Twenty-two percent of the patients had been treated for another cancer before the oesophageal epidermoid cancer, and in 19 percent of the cases this was a head and neck cancer. Thirty-five percent had a malignancy that was contemporary with the oesophageal cancer (this malignancy affected the head and neck in 18 percent of the cases and consisted of multiple lesions in 25 percent). During the short period under study, in only 10 percent of the patients did a cancer develop after the oesophageal one, and 6 percent of these affected the head and neck. This high incidence of associated neoplasia was due to tobacco and alcohol abuse. The presence of multiple cancers should alter as least as possible the treatment required by each associated cancer in order to optimize the chances of complete cure. Close surveillance of the high-risk population may result in the early discovery of a 2nd cancer at a curable stage. For the time being, the prevention of such associated cancers relies more on daily administration of retinoids than on alcohol and tobacco abstinence which is difficult to obtain.