Esophageal squamous cell carcinoma (ESCC) is common in the developing world, and is a leading cancer diagnosis in western Kenya. Tenwek Hospital is a 300 bed mission hospital located in Bomet District, Rift Valley Province, Kenya, approximately 200 miles northwest of Nairobi. Tenwek serves as a primary health care facility for approximately 400,000 people within a 50 km radius of the hospital. ESCC is the most common malignancy seen at Tenwek Hospital, and the patients show a very unusual age distribution, with about 8% of cases diagnosed at