Multiple primary cancers of the esophagus and lung were mostly reported in individual cases. Most patients visited a doctor because of dysphagia or respiratory symptoms. Chest CT can determine the location of lesions but cannot clearly determine the nature of lesions. Definite diagnosis needs bronchoscopy combined with gastroscopy, lung biopsy combined with gastroscopy or surgical operation to obtain pathological tissue. Recently, we confirmed a case of multiple primary cancer of the esophagus and lung by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and shared the diagnosis and treatment process. The advantages of this technique are that endobronchial ultrasound can determine the nature of mediastinal and hilar lesions, and needle aspiration biopsy is characterized by minimal invasion and repeatable biopsy, thus providing pathological diagnosis, especially for multiple primary cancers, that avoids misdiagnosis or missed diagnosis.