The tumor has spread into the upper part of the urethra, the upper part of the vagina, or to other parts of the body. Stage IV is divided into stages IVA and IVB. In stage IVA, (1) cancer has spread into the lining of the upper urethra, the upper vagina, the bladder, or the rectum, or has attached to the pelvic bone; or (2) cancer has spread to nearby lymph nodes and the lymph nodes are not moveable or have formed an ulcer. In stage IVB, cancer has spread to lymph nodes in the pelvis or to other parts of the body.