Background:- Esophageal cancer patients experience multifaceted challenges but studies often focus on the prevalence and risk factors of esophageal cancer with no documentation of the lived experiences of patients. This study aimed at exploring the lived experiences of esophageal cancer patients with the concept of uncovering pathways to seeking treatment, diagnosis, and follow-up. Methods:- A qualitative phenomenological study was conducted from September 01 to October 30, 2019. Data were collected from 25 patients (14 males and 11 females) through in-depth interviews using semi-structured interview guides and audio recordings. The data collectors’ notes and audio recordings were transcribed verbatim. The transcribed data were translated into English and coded using Atlas.ti.7.0.71 version software. Data were analyzed by the inductive thematic analysis method. Results:- The study demonstrated four main themes; experiences of symptoms of esophageal cancer, pathways to seeking treatment and diagnosis, barriers to treatment follow-up, and challenges of survival with esophageal cancer. The pathways to seeking and diagnosis were described with the concepts of self-care, visiting traditional healers, and hierarchical layers of health care delivery systems. The barriers to treatment follow-up were related to inaccessible and unaffordable health care services, and attitudes towards treatment. The challenges of survival with esophageal cancer were designated as problems with food intakes, treatment side effects, reduced quality of life, psychological and physical impairments. Conclusion:- Esophageal cancer patients in this study experienced complex pathways to treatment-seeking, multidimensional obstacles to treatment follow-up, and live with unbearable challenges.