Introduction: Cancer is a global burden and among the major causes of death in the world, with considerable variations among different countries and regions(Chirande 2011). Globally one out of eight deaths is caused by cancer and in developed countries childhood cancers contribute 10% of all childhood deaths. More than 85% of childhood malignancies occur in developing countries. Objective: The study aimed at determining the spectrum of disease in children presenting with oncological disorders attending Kilimanjaro Christian Medical Center. Methodology: A cross-sectional study was conducted at Kilimanjaro Christian Medical Center from April to May 2016. All children from less than one year to 13 years admitted in pediatric department at KCMC during the study period with confirmed diagnosis of malignancy were included in the study. An interview was conducted with mothers or caregivers followed by clinical assessment. Data was analyzed using SPSS v23.Descriptive statistics were used to analyze data. Mean, median with their respective measures of dispersion was used for continuous data, percentages were used for categorical Results: A total of 82 patients were enrolled in this study. The most common malignancy was retinoblastoma, followed by Burkitts Lymphoma then Wilm’s Tumor. Of these majority came with advanced disease. Most children with malignancy were between the ages of 1 to 4 years old. Few of the children died while others were sent for terminal care. Conclusion and recommendations: Retinoblastoma was the leading childhood malignancy at KCMC during the study period followed by Burkitts Lymphoma. Majority (85%) of patients reached KCMC late with advanced disease. Majority of patients recovered 38 (46.3%) compared to those who died 13(15.9%).There is a need for a multicenter study to establish the prevalence of childhood malignancies in North Tanzania and ascertain reasons for late presentation to hospital.