I always thought this type of cancer affected smokers
In Malaysia and beyond, laryngeal cancer is quietly dismantling a long-held assumption — that it belongs only to those who smoke. Kamaruzaman Abdul Rahim, a 57-year-old retiree who never touched a cigarette, lost his voice box to a disease he believed could never find him, a reminder that illness does not always follow the rules we assign it. The stories of those who speak now through electronic devices carry a deeper lesson about the fragility of the body and the cost of delayed attention. What medicine makes plain, and what these lives confirm, is that a voice taken early by a doctor's scope is a voice that need not be taken at all.
- Laryngeal cancer is striking non-smokers — people exposed only to secondhand smoke or environmental toxins — shattering the widespread belief that the disease is a smoker's burden alone.
- Because the cancer rarely causes pain and mimics something as ordinary as a cold, patients dismiss the warning signs for weeks or months, allowing tumors to grow until the only option is surgical removal of the voice box.
- Those who lose their larynx face consequences far beyond silence — permanent breathing through a neck stoma, difficulty swallowing, months of depression, and a lifetime of speaking through a robotic electronic device.
- One patient has faced four separate cancer diagnoses, enduring repeated rounds of chemotherapy and radiotherapy, while another quit smoking a decade before his diagnosis and was still not spared.
- Specialists are urging anyone with hoarseness lasting more than two weeks to seek immediate examination, stressing that early-stage laryngeal cancer can be treated with laser surgery or radiotherapy while the voice is still intact.
- Survivors are now turning their losses into advocacy, warning younger generations that the consequences of smoking and vaping are not distant possibilities but permanent, life-altering realities.
Kamaruzaman Abdul Rahim was 57 when a persistent hoarseness refused to leave. Doctors found stage-2 laryngeal cancer — a diagnosis that stunned him not because of its severity, but because he had never smoked. He had simply spent years breathing the same air as those who did. Today he speaks through a small electronic device held to his throat, his natural voice box surgically removed after an initial laser procedure failed to stop the cancer's return. "I always thought this type of cancer affected smokers or people who drink alcohol," he said. "Neither of which I did."
His experience is not exceptional. Dr. Nadhirah Shakri, an otorhinolaryngologist at Hospital Canselor Tuanku Muhriz in Kuala Lumpur, regularly treats patients who never smoked but developed laryngeal cancer through passive exposure to cigarette chemicals like formaldehyde. Vaping is emerging as an additional concern. The disease is particularly dangerous because it often causes no pain — a hoarse voice is easily mistaken for a cold, and by the time patients seek help, months may have passed and the tumor grown large enough to block the airway entirely.
When caught early, laryngeal cancer can be treated with laser surgery or radiotherapy, leaving the voice intact. But delayed diagnosis forces a laryngectomy — complete removal of the voice box — after which patients breathe through a permanent opening in the neck, struggle to swallow, and must relearn speech through electronic or mechanical means. Latib Rabu, 72, who smoked sixty cigarettes a day for over four decades, spent three months in total silence after his surgery before learning to use an electrolarynx. The emotional weight nearly broke him. He resigned from his career as a mechanical engineer to focus on recovery.
Lim Eng Chuan's ordeal has been still more relentless. He quit smoking nearly a decade before his diagnosis, yet the cancer returned three times — spreading from his voice box to his trachea and lung. He endured radiotherapy and chemotherapy simultaneously, and in January of this year received a fourth cancer diagnosis at the age of 63.
Kamaruzaman has chosen to transform his loss into purpose. He now leads the Malaysian Laryngectomee Association, supporting others on the same path, and speaks plainly to younger generations: the damage from smoking and vaping is not hypothetical. Dr. Nadhirah's message is equally direct — hoarseness lasting more than two weeks demands a specialist's attention. The difference between a scope examination and continued waiting may be the difference between a voice preserved and a voice lost forever.
Kamaruzaman Abdul Rahim was 57 when his voice began to fail him. A persistent hoarseness that should have been temporary lingered for weeks, then months, growing steadily worse. When doctors examined him, they found stage-2 laryngeal cancer. The diagnosis landed like a blow—not because he was unprepared for illness, but because he had never smoked. Neither had anyone in his family. He had spent his life around the habits of others, breathing the same air as colleagues and friends who lit cigarettes without thinking. That exposure, doctors would later explain, may have been enough.
Today, Kamaruzaman speaks through a mechanical device, a small electronic box that produces a synthetic voice when held to his throat. His natural voice box is gone, removed surgically after an initial laser procedure failed to stop the cancer's return. What strikes him most, he told an interviewer, is how thoroughly the disease contradicted everything he thought he knew about who gets sick. "I always thought this type of cancer affected smokers or people who drink alcohol," he said. "Neither of which I did."
He is not alone in that misconception, and he is not alone in the disease. Dr. Nadhirah Shakri, an otorhinolaryngologist at Hospital Canselor Tuanku Muhriz in Kuala Lumpur, sees patients regularly who never lit a single cigarette but developed laryngeal cancer anyway. Cigarette smoke contains formaldehyde and other chemicals that trigger malignant cell growth. Passive exposure—breathing the smoke exhaled by others—carries real risk. Vaping, too, has begun to emerge as a concern, though the science around it remains less settled than what we know about traditional tobacco. The disease is insidious partly because it often causes no pain. A person might dismiss a hoarse voice as a cold, a temporary strain, something that will pass. By the time they seek help, weeks or months have elapsed.
Early detection changes everything. When laryngeal cancer is caught in its early stages, doctors can treat it with laser surgery or radiotherapy, preserving the voice box and the person's ability to speak naturally. But delay allows the tumor to grow, sometimes large enough to obstruct the airway itself. At that point, removal becomes necessary. The surgery is not merely the loss of a voice. Patients who undergo laryngectomy—the removal of the entire larynx—must breathe permanently through an opening in the neck called a stoma. They experience difficulty swallowing. They must learn to speak again, if they choose to, using an electronic device that produces a robotic monotone, or through other methods that require retraining the body's mechanics of speech.
Latib Rabu, now 72, smoked sixty cigarettes a day for more than four decades, from 1972 until 2015. He quit immediately after his diagnosis, but the cancer had already taken root. After his voice box was removed, he spent three months in silence before learning to use an electrolarynx. The emotional toll was severe. "After the doctor confirmed I had cancer, I became deeply depressed," he said. "For several months, I struggled to accept it." He resigned from his job as a mechanical engineer to focus on treatment and recovery.
Lim Eng Chuan's story is even more harrowing. He quit smoking nearly a decade before his diagnosis, believing himself safe. The cancer returned not once but three times—first in his voice box, then in his trachea, where a three-centimeter tumor was discovered alongside another in his lung. He endured radiotherapy and chemotherapy simultaneously, a brutal combination. In January of this year, he was diagnosed with cancer for a fourth time and began another round of chemotherapy. He is 63 and a father of two.
Kamaruzaman, despite everything, has chosen not to be defined by his illness. He credits his family, his friends, and his medical team with giving him the strength to move forward. He now serves as president of the Malaysian Laryngectomee Association, an organization that supports others navigating the same journey. His message to younger people is clear: the consequences of smoking and vaping are not theoretical. They are permanent. They reshape a life.
Dr. Nadhirah's warning is simpler and more urgent: if your voice remains hoarse for more than two weeks, do not wait. See a specialist. Only an examination with a scope can reveal what is actually happening in your voice box. The difference between early detection and delayed diagnosis is the difference between keeping your voice and losing it forever.
Notable Quotes
I always thought this type of cancer affected smokers or people who drink alcohol—neither of which I did.— Kamaruzaman Abdul Rahim
If your voice remains hoarse for more than two weeks, don't ignore it. See a specialist because only an examination using a scope can reveal the true condition of the voice box.— Dr. Nadhirah Shakri, otorhinolaryngologist
The Hearth Conversation Another angle on the story
Why does laryngeal cancer surprise people when it shows up in non-smokers?
Because we've built a story in our heads that connects smoking to this disease so tightly that we assume it's the only real risk. But passive exposure is real—breathing someone else's smoke day after day, year after year. The chemicals are still there.
What's the actual moment when things change for someone like Kamaruzaman?
It's the hoarseness that won't go away. Two weeks becomes three. A month. And at some point you realize this isn't a cold. That's when you have to decide whether to ignore it or get it checked. That decision point matters more than anything else.
What happens to a person after the voice box is removed?
They lose the ability to speak the way they've spoken their whole life. They have to breathe through a hole in their neck. They have to learn a new way to make sound—through a device that sounds like a robot, or through other techniques that take months to master. It's not just medical. It's identity.
Why does Kamaruzaman seem so at peace with it?
He's chosen to move forward rather than be consumed by what was taken. And he's surrounded himself with people who support that choice. But that's not automatic. Latib Rabu spent months in depression after his surgery. The acceptance comes later, if it comes at all.
What would actually prevent these cases?
Early detection, mostly. If Kamaruzaman had seen a specialist in week two of the hoarseness instead of waiting, they might have caught it early enough to save his voice. And for the smokers—quitting before the damage is done. But once you're exposed, once the cells start changing, time becomes everything.