Bladder cancer represents the highest incidence of cancer among Egyptian patients accounting for 18.2% of all cancer patients. The high incidence is believed to be related to the prevalence of Bilharziasis reaching up to 40% in the Nile delta. The pathologic changes occurring in the wall of the urinary bladder due to Bilharziasis render it resistant to chemotherapy as well as radiotherapy. Accordingly we are evaluating the efficacy of Gemcitabine versus Epirubicin in the treatment of locally advanced and/or metastatic carcinoma of bilharzial bladder.