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Most children with cancer are diagnosed in early childhood, potentially resulting in missed developmental opportunities. The most common diagnoses—brain tumors, leukemia—are also associated with increased risk of neurocognitive deficits. Unfortunately, research regarding the functioning of preschool-aged children with cancer is limited. Our objective is to describe the cognitive and psychosocial functioning of preschool-aged children with cancer who completed a clinical evaluation at a hospital-based psychology clinic.Assessment data from 98 preschool-aged children with cancer (M = 5.17 years old, SD = 0.54; 54.1% male) who completed clinically referred evaluations from 2011 to 2015 were abstracted. Because of variability in assessment measures used across clinicians, indicators of cognitive, adaptive, preacademic, and emotional/behavioral functioning were collapsed before analyses.Children were 2.56 years from diagnosis (SD = 1.46, range 0–5.25 years) and most were off therapy (79.6%). Primary diagnostic categories were represented: brain tumor (68.4%), solid tumor (15.3%), and leukemia (16.3%). Mean IQ scores were significantly below expectations (t = −7.95, p < .001). There were no differences based on diagnostic category, treatment status, or sex. Adaptive functioning (t = −8.42, p < .001) and preacademic skills (t = −6.20, p < .001) were also significantly below expectations. Mean scores on a measure of parent-reported emotional/behavioral functioning were in the average range.Young children with cancer may be at significant risk of deficits in intellectual, adaptive, and preacademic functioning. Although our sample is biased by those who were referred for clinical evaluations, the severity of deficits highlights the potential vulnerability of young patients, even before most have entered formal school. Interventions—such as hospital-based preschool programs to increase preacademic skills—should be designed that explicitly target preschool-aged children and focus on a wide range of domains.