Squamous cell carcinoma (SCC) of the bladder is more commonly seen in Egypt due to schistosomiasis (bilharziasis) and accounts for 2% to 5% of all bladder tumours. Schistosomiasis is found in the bladder vasculature and leads to chronic inflammation causing squamous metaplasia, dysplasia and finally carcinoma. Studies have found involvement of other cancer pathways in tumourigenesis and aggressiveness such as inflammation, angiogenesis, apoptosis and cell proliferation. In this study, the authors look at a panel of biomarkers that are correlated to clinical outcome in patients who have had radical cystectomy for SCC. Between 1997-2003, 151 patients from Mansoura, Egypt who were treated with radical cystectomy (RC) and bilateral pelvic lymphadenectomy were included. Patients were followed up every two months for the first six months and then six monthly. Five biomarkers were found to be the best predictors of oncologic outcome of SCC: COX-2, p53, Bax, FGF-2 and EGFR. Alterations in COX-2 were associated with high-grade, advanced disease and COX-2 is also an objective predictor of oncologic outcome after RC. p53 has been noted to be the best predictor of outcome after RC for SCC. Increased Bax expression has been found in SCC, it has been associated with higher risk of disease recurrence. FGF-2 is involved in angiogenesis, cell proliferation, invasion and metastasis. FGF-2 is found in aggressive SCC that involves lymph nodes and can be used to predict disease recurrence and mortality of SCC. EGFR has not been well studied in SCC and in this study, alterations in EGFR have no correlation of pathological variables.