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Cervical tumors may occur in a variety of benign and malignant tumors. It is difficult to make a correct diagnosis in the absence of other systemic symptoms and pathological biopsy， which is likely to delay the optimal treatment opportunity. Patients diagnosed with esophageal cancer presenting with extensive cervical lymph node metastasis accompanied by pain as the initial symptom have been rarely reported in clinical practice. In the present study， a case of esophageal cancer presenting with extensive cervical lymph node metastasis as the initial manifestation was reported. The patient received multi-line treatment. Despite repeated disease progression， the patient obtained 33-month survival. In this article，clinical manifestations， diagnosis and treatment process and prognosis of this patient were reported， aiming to deepen the understanding of lymph node metastasis of esophageal cancer， improve the first visit rate， deliver early treatment， thereby obtain higher quality of life and longer survival.