Patients with a primary head and neck neoplasm are at risk for additional malignancies of the upper aerodigestive tract, which may be asymptomatic. This phenomenon may reflect the regional carcinogenic influence of alcohol and tobacco abuse. A review of the recent literature documents the value of performing laryngoscopy, bronchoscopy, and esophagoscopy on all patients being staged for head and neck tumors to identify second synchronous cancers, the presence of which may significantly alter the treatment plan.