We reviewed the cases of paediatric malignancy at Port Moresby General Hospital (PMGH) over the 18 months between June 2014 and December 2015 and compared diagnoses and outcomes with previously reported data. Children with paediatric cancer account for 0.5- 1% of admissions to the PMGH Paediatric Unit and around 0.4% of admissions to provincial hospitals. Efforts to improve outcome have included establishment of linkages with and practical experience at the Children’s Cancer Centre of the Royal Children’s Hospital in practical supportive care measures established. Potentially curative chemotherapy was started on 26 of the 47 patients in the series, of whom 13 are known to have died. Better outcomes are possible within our setting. We have a paediatrician with considerable and appropriate expertise in paediatric oncology, linked to a centre of excellence in Australia, but we will need a dedicated Paediatric Cancer Unit, separate from the highly infectious paediatric wards and with its own staff. Local community support for such a unit will be required.