A Rare and Aggressive Cancer
By James Myhre & Dennis Sifris, MD
Published on August 01, 2023
Medically reviewed by Peter Weiss, MD
Women can very rarely develop cancer in a pair of organs called the Skene's glands, which originate from the same tissues in an embryo that give rise to the prostate gland. Women cannot get prostate cancer because they don't have prostate glands like men.
Unlike prostate cancer, which is the second most common cancer in men,1 Skene's gland cancer is exceptionally rare, with only 20 cases reported in medical literature as of 2022.2
This article explains what the Skene's glands are and how cancer develops there. It also describes the signs and symptoms of Skene's gland cancer and how the condition is diagnosed and treated. It will also discuss Skene's gland cysts, a benign condition.
Maskot / Getty Images
Gender Definitions
For the purpose of this article, "female" and "women" refer to people born with a vagina, and "male" and "men" refer to people born with a penis, irrespective of the gender or genders they identify with. When research or a health authorities are cited, the gender terms used reflect those used in the cited source.
Types of Cancers Affecting Females
Skene’s Glands
Skene's glands, also known as the lesser vestibular glands or paraurethral glands, are a pair of pea-sized glands situated near the end of the urethra (the tube through which urine exits the body).3
Skene's glands originate from the same cells that give rise to the prostate gland during embryogenesis. Embryogenesis is the process in which a fertilized egg starts to divide and differentiate into specialized cells that make up various tissues and organs in the body.
The differentiation of the prostate gland and Skene's glands depends on whether the embryo carries a gene called the sex-determining region Y (SRY) gene.4
This SRY gene triggers the production of testosterone and other androgen sex hormones, causing embryonic tissues to develop into male sex organs, including the prostate gland.4
In embryos without the SRY gene, the absence of testosterone during this period of development causes tissues to develop into female sex organs, including the Skene's glands.4
What Do Skene's Glands Do?
There remains some debate as to the function of Skene's gland, but it is generally agreed that the milk-like fluid they secrete helps lubricate the opening of the urethra.5
The Skene's gland is similar to the prostate gland in that it secretes fluids that contain prostate-specific antigen (PSA). This is the same substance that healthcare providers use to detect an enlarged prostate.5
It is thought that because the prostate gland secretes fluid that makes up semen, the fluids secreted by Skene's glands may be responsible for "female ejaculation," which can occur with orgasm.6
Cancer of the Skene's Gland
Women cannot get prostate cancer. But women can get Skene's gland cancer, otherwise known as female urethral adenocarcinoma (FUA). It is an extremely rare cancer.7
By way of background, carcinoma is a type of cancer that affects epithelial cells. These are the cells that form the covering of all body surfaces, including the lining of body cavities and hollow organs. Most cancers affecting the skin, breasts, kidneys, liver, lungs, pancreas, prostate gland, and head and neck are carcinomas.8 Those affecting glandular tissues are called adenocarcinoma.9
While other types of cancers can affect the female urethra (including squamous cell carcinoma and clear cell carcinoma), FUA specifically involves the Skene's glands.10
FUA is extremely rare, accounting for less than 0.003% of cancers affecting the female genital and urinary tract. It is also very aggressive, causing large tumors that spread quickly through the lymphatic system. Most cases are not detected until the cancer has metastasized (spread to distant organs).2
How Serious Is Skene's Gland Cancer?
Female urethral adenocarcinoma has a high mortality rate, mainly due to late diagnosis of the disease. The five-year survival rate for all female urethral cancers is around 44%.11 With FUA specifically, the survival rate is closer to 31%—meaning that only one in three people will live for five years or more following their diagnosis.11
What to Know About Urethral Cancer
Symptoms of Female Urethral Adenocarcinoma
Female urethral adenocarcinoma is frequently asymptomatic (without symptoms) in the early stages. It is only when the tumor grows to a notable size that a person may feel and/or see it as a hardened nodule (lump) with a round surface.12
The location of the nodule can vary based on where the tumor started. Those that originate in the duct of a Skene's gland can cause a nodule on the labia minora (the inner skin flaps on either side of the vagina).13 Those that start in the gland itself can cause a nodule on the labia majora (the outer skin flaps on either side of the vagina).2
The nodule will typically be painless but can cause pain if it presses on a nerve or adjacent structures.2 The nodule can range in size from under 1 centimeter (0.4 inches) to well over 4 centimeters (1.5 inches).14
Urinary Symptoms
With FUA, urinary symptoms can occur when the tumor penetrates the lining of the gland and invades the adjacent urethra. When this happens, a person may develop symptoms similar to a urinary tract infection (UTI).7
The symptoms can vary based on whether the distal urethra (near the opening of the urethra) or the proximal urethra (closer to the bladder) is involved. Proximal tumors tend to be more severe.11
Pratama ME, Ismy J, Kamarlis R, Mauny MP. Female primary urethral carcinoma: a rare case report. Int J Surg Case Rep. 2021;85:106100. doi:10.1016/j.ijscr.2021.106100
Symptoms of FUA may include:11
Pain with urination (peeing)
Difficulty peeing or starting a urine stream
A weak or interrupted (stop-and-start) urine stream
A strong urge to pee even when you can't
Inability to fully empty the bladder
Bladder leakage
Frequent urination at night
Blood in the urine
Blood from the urethra
Vaginal, rectal, or perineal pain
Pain with sexual intercourse
When FUA is advanced and has begun to spread, a person may experience chronic back pain, severe fatigue, unexplained weight loss, and swollen lymph nodes in the groin. Common sites of metastases are the bladder, vagina, liver, lungs, brain, and bones.15
Signs and Symptom of Urethral Cancer
Treatment and Outlook
The treatment of female urethral adenocarcinoma depends on the cancer stage. The stage describes how advanced the cancer is based on the size and extent of the tumor, whether nearby lymph nodes are affected, and whether or not metastasis has occurred.16
The treatment of FUA typically involves surgery with or without chemotherapy and radiation therapy.
Early-Stage Tumors
Noninvasive, localized tumors are treated with localized surgery. This may involve a surgical procedure called a transurethral local resection that removes the tumor and some of the surrounding tissue while preserving the urethra.15 This is similar to the transurethral resection of the prostate (TURP) used in people with a prostate.
Another procedure called transurethral laser vaporization may be appropriate for smaller tumors, especially those near the opening of the urethra.15 The procedure literally vaporizes the tumor while also preserving the urethra.17
In cases in which resection or laser surgery cannot be performed, radiation therapy has been used successfully.15
Advanced Tumors
Invasive, advanced tumors are treated with a combination of surgery, radiation, and chemotherapy.15
The surgery involves a radical urethrectomy, a procedure that removes the entire urethra all the way up to the bladder neck, as well as a large area of surrounding tissues and muscles. In addition to removing the tumor and Skene's glands, some of the vaginal wall may also be removed.7
Prior to surgery, a combination of radiation and chemotherapy—known as neoadjuvant chemoradiotherapy—is recommended help shrink the tumor and improve outcomes.18
Prognosis
The prognosis of FUA is generally poor for people whose cancer has spread to nearby lymph nodes or has metastasized.7 Those whose cancer remains localized can expect to live longer; even so, the odds of recurrence are significant.18
Studies suggest that the average survival time for people with localized disease is 99 months, while those with locally advanced or metastatic disease have a survival time of around 36 months with the appropriate treatment.18
The combination of surgery, radiation, and chemotherapy is key to survival in advanced cases. People treated with surgery, radiation, or chemotherapy alone lived half as long (18 months) than those who had undergone all three treatments.18
Even so, a person's quality of life can be significantly reduced after a radical urethrectomy. Counseling and support may be needed to adjust to necessary interventions such as a urostomy (used in place of normal urination to drain urine from the bladder with a tube inserted through the abdominal wall).7
Why Bladder Cancer Is Common in Females
Associated Conditions
Skene's glands are vulnerable to conditions beyond cancer. While these other conditions are far less serious, they can cause significant pain and other symptoms.
Skene's Gland Cysts and Abscesses
Skene's gland cysts are fluid-filled sacs that can develop inside the gland or in the duct of the gland. Most of the cysts are small and asymptomatic.3
However, some can grow quite large and cause symptoms such as:3
A slightly movable lump near the opening of the urethra
Frequent urination
Painful urination
Difficulty urinating
Pain with sexual intercourse
Frequent urinary tract infections
Skene's glands cysts often develop in adults when the duct is blocked by a bacterial infection. In some cases, the infection can lead to a pocket of pus known as an abscess.3
Skene's gland cysts can also occur as a congenital condition (a condition you are born with) in one of every 2,000 to 7,000 newborns, The cause of this is unknown.19
A Skene's gland cyst can be removed with surgery. Cysts and abscesses can also be drained with a needle (known as needle aspiration). Antibiotics may be prescribed if an infection is involved.3
Adenofibroma
Adenofibroma, also known as a fibroadenoma, is a benign (noncancerous) tumor that usually develops in the breasts, ovaries, or uterus of postmenopausal people. They can range anywhere from 1 to 15 centimeters in size and cause a variety of symptoms depending on where they are located.20
Adenofibromas differ from other benign tumors in that they affect both glandular tissues and fibrous connective tissues. They are most common in postmenopausal people who use estrogen replacement therapy.20
The Skene's glands are a rare site for adenocarcinoma. The tumor can develop in the duct of the gland or in the gland itself. A person with Skene's gland adenofibroma may be asymptomatic if the tumor is small, but large ones can cause:21
A painless, firm, reddish nodule near the opening of the urethra
Pain with urination
Pain with sexual intercourse
Adenofibromas of the Skene's gland can usually be removed with surgery.21
What Is a Urethral Caruncle?
Summary
Women cannot get prostate cancer, but they can get female urethral adenocarcinoma (FUA) in the Skene's glands. which are the counterpart to the prostate gland in males. FUA is exceptionally rare, with only around 20 documented cases in medical literature. Even so, FUA is known to be aggressive, with a high rate of mortality.
Early-stage tumors can be removed surgically, but advanced tumors generally require the removal of the urethra and surrounding tissues preceded by a course of chemotherapy and radiation.
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