A right cervical squamous cell carcinoma metastasis was histologically confirmed externally in the patient. With an initial suspected diagnosis of CUP syndrome, a cT1 hypopharyngeal carcinoma was histologically confirmed as the primary tumor during a panendoscopy. In addition to unclear esophageal changes, clarification by our colleagues in Medicine 1 revealed a CIS 24 cm from the tooth row with additional unclear lung findings. In our interdisciplinary tumor conference, it was decided that the primary surgical treatment of the hypopharyngeal carcinoma would be re-evaluation and, if necessary, endoscopic resection of the esophageal findings and monitoring of the lung findings.