<p>Acute abdominal pain in oncology patients is a growing diagnostic challenge driven by an aging population, prolonged survival following diagnosis, and an expanding range of systemic and locoregional therapies. Clinical assessment is frequently unreliable in this population, as immunosuppression can mask peritoneal signs and laboratory abnormalities, shifting the diagnostic burden toward imaging. This review presents a system-based overview of acute abdominal emergencies in patients with cancer, organized into hepatopancreaticobiliary, luminal gastrointestinal, and genitourinary categories. Each category encompasses a spectrum of tumor-related, systemic, and treatment-related etiologies with characteristic computed tomography features. Given the complexity of these patients, the radiologist’s role extends beyond image interpretation to include integration of oncologic context and timely communication of critical findings.</p>