Authorship contribution AA and GM designed and wrote the article. Both read and approved the final version of the manuscript.
During the last few decades cure rates in children and adolescents with malignant diseases have approached 75–80 %. While this has been mainly achieved by a reduction of relapses, nowadays, prevention of disease- and therapy-related deaths has come more and more into focus. Initial emergencies in pediatric hematology and oncology represent rare but life-threatening situations which can be recognized by the combination of a patient’s medical history, age, clinical symptoms, laboratory parameters, and imaging studies. In the present review, both disease- and therapy-related oncological emergencies will be described including tracheal collapse and superior vena cava syndrome in case of mediastinal tumors, intussusception and inferior vena cava syndrome in case of abdominal tumors, intracranial hypertension in brain tumors, spinal cord compression in case of dumbbell tumors as well as tumor lysis syndrome and coagulation disorders. Possible differential diagnoses of malignant diseases and type and risk of the diagnostic procedures will be described in detail, emphasizing that all diagnostic procedures should be done appropriately and rapidly at experienced and specialized pediatric hematologic–oncological institutions in order to prevent fatality or irreversible damage.