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Bladder cancer is the 5th most common cancer and is much more common in smokers. reviews the basic biology and pathophysiology of bladder cancer, focusing on methods used to detect bladder cancer, treatment of early-stage disease with therapies administered into the bladder, the role of surgery or radiation therapy in the treatment localized disease, the role of chemotherapy for metastatic disease, and new directions in the field, particularly the role of immunotherapy in bladder cancer.