Incidence rates have risen for gastric cardia adenocarcinoma, whereas rates have remained stable for esophageal squamous cell carcinoma in many western countries. The aim of this study was to describe and analyze trends in incidence rates for esophageal cancer and gastric cardia cancer in Cixian county, which is one of the high-risk areas for esophageal cancer in China as well as in the world. The data were obtained from the Cixian Cancer Registry, which is a population-based registry. All the data were checked and analyzed using SPSS 11.5. Between the years 1988 and 2003 there were 11183 cases of esophageal cancer in the county. The age-standardized incidence rate was 168.55 per 100 000. In 1988, the age-standardized incidence rate for male patients was 250.76/100 000; it declined to 160.05/100 000 in 2003, representing a decrease of 36.2%. The age-standardized incidence rate for female patients was 153.86/100 000 in 1988; it declined to 82.55/100 000 in 2003, showing a decrease of 46.3%. A slight decreasing trend was observed during the period, with a yearly decrease of 3.61% in male patients and 3.39% in female patients. For gastric cardia cancer, there were 1654 cases from 1988 to 2003. The age-standardized incidence rate was 25.58 per 100 000. The age-standardized incidence rate for male patients was 13.75/100 000 in 1988; it increased to 28.55/100 000 in 2003, with a yearly increase of 7.65%. The age-standardized incidence rate for female patients was 7.12/100 000 in 1988; it increased to 12.91/100 000, with a yearly increase of 5.44%. A statistically significant increasing trend of gastric cardia cancer was observed during the study period. Cixian county is a geographical region with a very high incidence of esophageal cancer and cardia cancer. The trend in the incidence rates of esophageal cancer had decreased slightly; on the other hand, gastric cardia cancer showed a significantly increased trend in the last 16 years. Detailed epidemiological analyses of demographic trends and risk factors will help to guide future cancer control strategies.