Cancer has spread to the bladder, rectum, or other parts of the body. Stage IV is divided into stages IVA and IVB. In stage IVA, cancer has spread to the bladder or rectal wall and may have spread to lymph nodes in the pelvis. In stage IVB, cancer has spread beyond the pelvis and pelvic lymph nodes to other places in the body, such as the abdomen, liver, intestinal tract, or lungs.