Stage IV includes: (T4, N0, M0); (Any T, N1, M0); (Any T, N2, M0); (Any T, N3, M0); (Any T, Any N, M1). T4: Tumor invades adjacent organs, or through the kidney into perinephric fat. N0: No regional lymph node metastasis. N1: Metastasis in a single lymph node, 2 cm or less in greatest dimension. N2: Metastasis in a single lymph node, more than 2 cm but not more than 5cm in greatest dimension; or multiple lymph nodes, none more than 5 cm in greatest dimension. N3: Metastasis in a lymph node, more than 5 cm in greatest dimension. M0: No distant metastasis. M1: Distant metastasis. (AJCC 7th ed.) [from NCI]