Colorectal carcinoma (CRC) is the third leading cause of cancer-related deaths in the United States, in Egypt, CRC is third most commonly diagnosed cancer in males and second in females. Approximately one-half of colorectal carcinoma patients already have metastases at the time of diagnosis. Apoptosis is a form of cell death which is regulated at gene level and plays a central role in neoplastic transformation main group of genes controlling apoptosis is bcl family, which includes both promoters and inhibitors, anti-apoptotic protein Bcl-x seems to play major role in colorectal tumorigenesis and progression, a shift from expression of bcl-2 to Bcl-x has been demonstrated during progression of colorectal tumors, and significant Bcl-x overexpression has been found in many cancer patients when compared with corresponding normal tissue, elevated expression of cyclooxygenase-2 (COX-2), the inducible isoform of prostaglandin H synthase, has been found in several human cancers, including colorectal cancer (CRC), this appears as rationale for the chemo-preventive effects of non-steroidal anti-inflammatory drugs in CRC. However, relation between Bcl- x and COX-2 expression from adenomas to carcinomas on one side and their relation to patient’s outcome in colorectal carcinoma cases is not fully understood.