If the following events were placed in chronological order which would come fourth?

The answer is E. Heavy alcohol intake (C) is associated with the development of oesophageal carcinoma in Western Europe. An early symptom of oesophageal carcinoma is dysphagia (B); surgical treatment may be impossible and palliative oesophageal bouginage undertaken (D). This may be complicated by oesophageal rupture, but occasionally the tumour itself extends locally into the trachea and a fistula may be formed (E) with resultant aspiration bronchopneumonia (A).