The concept of rapid assessment, evaluation, and management of symptoms due to malignancy is generally accepted. Inherent in this concept is rapid reversal of what is reversible. Some acute events in malignancy have to be treated as an emergency if a favourable outcome is to be achieved. As in any emergency, the assessment must be as prompt and complete as possible. In patients with advanced malignancy, factors to consider include x The nature of the emergency x The general physical condition of the patient x Disease status and likely prognosis x Concomitant pathologies x Symptomatology x The likely effectiveness and toxicity of available treatments x Patients’ and carers’ wishes. While unnecessary hospital admission may cause distress for the patient and carers, missed emergency treatment of reversible symptomatology can be disastrous.