Dr. Sukrit Singh Sethi September 10, 2025

The Silent Cancer of the Ganges:

Why Even Harmless Gallstones Can’t Be Ignored

In the crowded towns and villages along the Ganges River, gallstones are almost part of daily life. Many people ignore them, especially when they cause no pain. But in the Ganges basin, doctors recognize a grim truth: even asymptomatic gallstones can become the first step toward gallbladder cancer-a malignancy among the deadliest in India.

A Cancer Corridor in India and Beyond

Gallbladder cancer is rare worldwide. In the United States, its incidence is under 2 per 100,000 women. In northern India, especially along the Ganges, the figure climbs to 9–10 per 100,000 women—among the world’s highest. Similar patterns emerge in the Amazon basin of South America, where gallstones and environmental exposure combine to create another hotspot.

Women in India’s Gangetic plains are disproportionately affected, with a female-to-male ratio of 3-4.5:1. Multiparity, early pregnancies, and long hormonal exposure increase their risk. By the time many patients reach hospitals in Varanasi, Patna, or Lucknow, disease is already advanced.

Gallstones: Harmless Elsewhere, Deadly Here

Globally, only 1-3% of patients with gallstones develop cancer. But in the Ganges and Amazon basins, gallstones are implicated in 80-90% of gallbladder cancer cases. The answer lies in the environment: water and food samples reveal arsenic, nitrates, chromium, and lead-all linked to cancer. Adulterated mustard oil and chronic infections worsen the risk. Living closer to the Ganges correlates directly with higher gallstone prevalence and gallbladder cancer incidence.

Why Asymptomatic Gallstones Require Surgery

In most of the world, doctors follow the rule: leave asymptomatic gallstones alone. But in India’s high-risk corridor, this advice no longer applies. Prophylactic cholecystectomy-removal of the gallbladder even before symptoms—has become a cancer prevention strategy.

• Laparoscopic cholecystectomy: the gold standard, minimally invasive, quick recovery.
• Robotic cholecystectomy: emerging technology, high precision in specialized centers.
• Open cholecystectomy: still essential in complex cases or resource-limited settings.
• Radical cholecystectomy: mandatory when gallbladder cancer is confirmed, removing adjacent liver tissue and lymph nodes.

Gallbladder Polyps: Silent Precursors

Beyond stones, gallbladder polyps deserve attention. Polyps larger than 10 mm, those growing rapidly, or those linked with gallstones or PSC should be surgically removed. In high-risk zones, even smaller polyps warrant ultrasound surveillance every 6-12 months.

Read also: India’s Hidden Cancer Crisis

Every Gallbladder Needs a Biopsy

Another key principle in gallbladder cancer prevention: every gallbladder specimen must be sent for biopsy. Even when cancer isn’t suspected, microscopic examination often reveals early or incidental malignancy. A negative pathology report confirming no dysplasia or carcinoma is the only safe endpoint.

A Call to Action

The Ganges basin is not just a lifeline; it is also a cancer corridor. What may be a harmless gallstone in New York can be a silent warning of cancer in India. By embracing early surgery, surveillance of gallbladder polyps, and routine biopsy, doctors in high-risk regions can save lives.

The lesson is clear: not all gallstones are the same. In the Ganges and Amazon basins, even the quiet ones can kill.

References

1. Lazcano-Ponce EC, et al. Epidemiology and risk factors for gallbladder cancer. Int J Cancer. 2001.
2. Randi G, et al. Epidemiology of gallbladder cancer. Clin Epidemiol. 2009.
3. Dixit R, et al. Gallbladder cancer in India: Epidemiology and management. J Gastrointest Oncol. 2019.
4. ICMR Consensus Guidelines for Gallbladder Cancer. Indian Council of Medical Research.

Disclaimer
This article is for informational purposes only and should not be considered a substitute for professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.