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It is reported that hypopharyngeal cancer has the highest risk of second primary cancer among head and neck cancers, particularly the development of synchronous or metachronous second primary malignancies, with the most common sites being in the oesophagus, the lung and the urinary tract [46, 47]. Second primary cancers after head and neck cancer are mostly found in the upper aerodigestive tract, including the lung and oesophagus [48–50]. When restricted to early-stage hypopharyngeal cancer, 56–83% of patients develop a second primary malignancy [50]. The use of image-enhanced endoscopic examination of the oesophagus, in all patients diagnosed with hypopharyngeal cancer, both pre- and post-treatment are to be recommended [51]. The most frequent second primary cancer detected in patients with hypopharyngeal cancer in Japan and Taiwan is oesophageal carcinoma [49, 52, 53], which differs from results from the developed world studies, which is the lung [49, 50, 54]. Suggestion to explain these national and regional variations of cancer incidences is likely due to differences in dietary, social habits as well as environmental exposure between cultures [49].