Muscle invasive bladder cancer (MIBC) is an aggressive disease which arises de novo in 80–90% of cases. Tobacco smoking, occupational exposure to various dyes, environmental exposure to radiation and chemicals, medications and Schistosoma infections are the most established risk factors. All of these cancers are high grade urothelial cancers, but identification of morphological subtypes is done for prognostic and predictive significance. Symptoms include painless haematuria, urgency, dysuria, increased frequency and, in more advanced tumours, pelvic pain and symptoms related to urinary tract obstruction. Diagnosis is typically made through radiological imaging, cystoscopy, biopsy and/or resection of tumour. Treatment options include surgery, chemotherapy, and radiation therapy. Trimodality therapy is the standard bladder conservation therapy which incorporates cystoscopy with maximal visible transurethral resection of bladder tumour (TURBT) followed by radiation therapy (RT) with concurrent chemotherapy. Long-term close surveillance and follow-up are critical in bladder cancer due to high risk of recurrences. Follow-up involves regular monitoring with biochemistry, imaging and cystoscopies to detect any recurrence or metastasis.