Although the majority of worldwide bladder cancer patients presented with disease confined to the superficial layers of the bladder wall, approximately one-quarter of patients will present with or subsequently develop invasive cancer. In Egypt, these invasive stages represent 80 95% of the whole population of bladder cancer patients. Moreover, patients who underwent radical cystectomy of the superficial tumor (P0) represented 0.3% of the 4,541 total patients compared with 20.2% of 1,054 patients in the US.Advanced stages (P2b, P3 and P4) accounted for 81.5% and 94.5% in the studies by Ghoneim et al. and Zaghloul et al. respectively, compared with 49.1% in that of Stein et al. Locally advanced bladder cancer portends a poor prognosis. In Europe, physicians have favored radiation and chemotherapy, whereas in North America, Egypt, and other parts of the world the direction is toward surgical extirpation.

The relative frequency of transitional cell carcinomas (TCC) in cystectomy specimens increased in the National Cancer Institute (NCI), Cairo from 30.5% in the period 1988 1991 to 44.1% in the period 1998 2001, minimizing the differences between bilharzial (schistosomal) and non-bilharzial categories. The differences between bilharzial and non-bilharzial series were mainly the younger age at presentation, late presentation, larger size of the tumor and mucosal inflammation due to bilharzial infestation and deposition of eggs, which may affect the response to therapy and the bladder extension capability.Not much difference was proven in the natural history or in the method of spreading.