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Malignant tumors registered with the Tumour Registry of Papua New Guinea (PNG) from 1958-1988 were analyzed with emphasis on the variation of incidence with time and different regions. Cancer incidence was generally low in PNG. During this period, carcinoma of oral cavity, cervix, breast, and skin, hepatoma, and lymphoma were the most common types of malignant lesions detected. The incidence of carcinoma of the oral cavity has increased. Currently, it is more common in the Highlands region and is associated with the spread of betel nut chewing. A threefold increase in cervical carcinoma registration was observed nationally, with a sixfold increase in the Highlands region; this was attributed both to social changes and improved registration. The incidence of breast cancer has doubled, in keeping with better registration, but there is little interregional variation. The decline in registrations of hepatocellular carcinoma is artifactual. PNG is a high-incidence area for Burkitt lymphoma, but Hodgkin disease is rare. Both Burkitt and other non-Hodgkin lymphomas are uncommon in the Highlands. A decline in the incidence of squamous carcinoma of skin was observed that was associated with improved control of tropical ulcers. The incidence of stomach cancer is falling. The registered cancer incidence in PNG is low, even when compared with that in native people from other Pacific nations, such as Fijians and New Caledonian Melanesians. Preventive measures have been hitherto ineffective, with the exception of squamous carcinoma of skin.

This article describes differences in professional oncology practice between Papua New Guinea and developed countries. The rugged terrain and tribalism have created the late persistence of a stone age culture with a low level of education and this in turn has caused the late presentation of tumours. Paradoxically the commonest cancers are those which are frequently cured in Western countries, yet the cure rates are low in PNG due to late presentation. Despite this very few metastasize--in contrast to cancers in developed countries. Difficulties in diagnosis are discussed. Differences in management arise due to lack of facilities such as electrons or iridium wires, but policy differences arise also due to the poor follow-up. Many patients cannot afford to return for follow-up and the government cannot assist. Many patients abscond and good pre-treatment counselling is essential. Chemotherapy is available but doses of the more marrow-toxic or expensive drugs are reduced in view of the poor support facilities. Problems of training staff and of Cancer Registration are discussed. Most of the above problems are non-medical and should gradually diminish with government determination to provide a Health Service to benefit the whole population.

A retrospective study was carried out on Ewing's sarcoma as seen between 1973 and 1987 at the Cancer Treatment Centre, Angau Memorial Hospital, Lae, Papua New Guinea. Some striking differences were observed in the epidemiological indices and the clinical picture of this disease here, when compared with other centres in the world. Most notably, Ewing's sarcoma, hitherto a rare tumour in this country, seems to be on the increase. In addition, among the flat bones, involvement of the scapula was disproportionately high. The early response to treatment was similar to findings elsewhere, although the long-term patient follow-up in this series was not satisfactory enough to allow proper estimates of long-term survival rates. The most recently advocated approach to the management of Ewing's sarcoma, which emphasizes surgery in preference to radiotherapy for local disease control, and adjuvant chemotherapy for micrometastases, is outlined.