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Tumor acidosis affects every stage of cancer development, from dysplasia to full-blown metastatic disease. Survival strategies of malignant cells in an acidic microenvironment and pH gradient inversion promote resistance to chemotherapy, radiotherapy and immunotherapy, and suppress the antitumor immune response. It is necessary to consider the low pH of the microenvironment both when diagnosing and when choosing the most optimal treatment regimen. The development of methods for non-invasive measurement of tumor pH, methods for direct and indirect correction of acidosis, new pH-activated and pH-targeted drugs is required. In this work, we consider some aspects related to the altered acid-base state of the tumor, which may be significant for the clinician.