1) Never ever trust user input
2) Make sure you do a session_regenerate_id when your user for example logs in to clear out any session riders (session fixation)
Sessions can be manipulated, what comes from a session must always be validated, all the time, everytime. Your next "fear" is that someone gets another persons session id and uses it on his own browser to "ride" on that users "state".
Thats all I can think of at this point.