Bladder cancer is the fifth most common form of cancer worldwide and is mainly prevalent in developed countries. It is thought to arise through two distinct pathways: the noninvasive and the invasive. The noninvasive pathway gives rise to a superficial papillary carcinoma that is characterized by activating mutations in oncogenes such as H-ras, FGFR3 and PI3K. This pathway is rarely lethal as superficial papillary carcinomas can be readily removed through transurethral resection. However, 15% of noninvasive urothelial tumors can transform into invasive carcinomas and have high recurrence (80% of the cases) that requires intensive surveillance and repetitive treatment. This book discusses the risk factors of bladder cancer, as well as the emerging treatment strategies and challenges.