In the patient, a cT4a cN2b hypopharyngeal carcinoma on the right was histologically confirmed during a panendoscopy <2014>. Hypopharyngeal carcinoma in the area of the right piriform sinus with infiltration of the laryngeal skeleton. In our interdisciplinary tumor conference, the primary surgical procedure with laryngectomy and partial pharyngectomy was recommended. In the preoperative course, the right-sided lymph node metastases were significantly enlarged. The CT scan performed immediately before the operation showed a primary tumor that was largely unchanged in size and now had a cN3 neck status with a lymph node metastasis measuring over 10 cm on clinical and computed tomography as a conglomerate on the right. There was still no evidence of distant metastasis, so that the primary surgical procedure could be confirmed.