Cancer is a major cause of death worldwide, and its impact is especially heavy in low- and middle-income countries where health systems are weak and access to care is limited. In Kenya, cancer was the second leading cause of death in 2024, with the problem compounded by late diagnosis, low awareness and poor access to services. This community-based cross-sectional study used a mixed-methods approach – combining a household survey (n = 1,410) with key informant interviews and focus group discussions – to quantify and describe the cancer burden in Wajir County. The household-level cancer prevalence was 3.22%, with Wajir East recording the highest burden at 5.58%. Oesophageal cancer was the dominant malignancy, representing 48.9% of reported cases, and was most common among men aged 61–70 years. Most cancers (86.7%) were diagnosed at advanced stages (III/IV), and the mortality rate among identified cases reached 80%. Awareness and preventive engagement were very low: only 6.9% of respondents had ever received cancer prevention education, 3.1% had been screened, and 97.2% reported never having routine medical check-ups. Access to treatment and palliative care was highly constrained, with many patients referred to distant facilities in Nairobi or Garissa, often unable to complete treatment because of financial and logistical barriers. Qualitative data highlighted stigma, misconceptions and fatalistic views about cancer, all of which further delayed care-seeking. Overall, the findings point to an urgent need for socially appropriate cancer education, targeted risk reduction and strengthened oncology and palliative care services, alongside broader investments in health financing, workforce and supply chains to improve cancer outcomes in Wajir County and similar settings.