```xml
<?xml version="1.0" encoding="UTF-8" standalone="yes"?>
<ns4:query_definition xmlns:ns2="http://www.i2b2.org/xsd/cell/crc/psm/1.1/" xmlns:ns4="http://www.i2b2.org/xsd/cell/crc/psm/querydefinition/1.1/" xmlns:ns3="http://www.i2b2.org/xsd/cell/crc/psm/analysisdefinition/1.1/">
    <query_name>Distant metasta@20:23:08</query_name>
    <query_timing>ANY</query_timing>
    <specificity_scale>0</specificity_scale>
    <panel>
        <panel_number>1</panel_number>
        <panel_timing>ANY</panel_timing>
        <panel_accuracy_scale>100</panel_accuracy_scale>
        <invert>0</invert>
        <total_item_occurrences>1</total_item_occurrences>
        <item>
            <hlevel>3</hlevel>
            <item_name>Malignant neoplasms</item_name>
            <item_key>\\i2b2_DIAG\i2b2\Diagnoses\Neoplasms (140-239)\Malignant neoplasms (140-208)\</item_key>
            <item_icon>FA</item_icon>
            <tooltip>Diagnoses \ Neoplasms \ Malignant neoplasms</tooltip>
            <class>ENC</class>
            <constrain_by_modifier>
                <modifier_name>Distant metastasis cannot be evaluated</modifier_name>
                <modifier_key>\\i2b2_DIAG\TNM\Metastisis\MX\</modifier_key>
                <applied_path>\i2b2\Diagnoses\Neoplasms (140-239)\Malignant neoplasms (140-208)\%</applied_path>
            </constrain_by_modifier>
            <item_is_synonym>false</item_is_synonym>
        </item>
        <item>
            <hlevel>3</hlevel>
            <item_name>Malignant neoplasms</item_name>
            <item_key>\\i2b2_DIAG\i2b2\Diagnoses\Neoplasms (140-239)\Malignant neoplasms (140-208)\</item_key>
            <item_icon>FA</item_icon>
            <tooltip>Diagnoses \ Neoplasms \ Malignant neoplasms</tooltip>
            <class>ENC</class>
            <constrain_by_modifier>
                <modifier_name>Distant metastasis is present</modifier_name>
                <modifier_key>\\i2b2_DIAG\TNM\Metastisis\M1\</modifier_key>
                <applied_path>\i2b2\Diagnoses\Neoplasms (140-239)\Malignant neoplasms (140-208)\%</applied_path>
            </constrain_by_modifier>
            <item_is_synonym>false</item_is_synonym>
        </item>
        <item>
            <hlevel>3</hlevel>
            <item_name>Malignant neoplasms</item_name>
            <item_key>\\i2b2_DIAG\i2b2\Diagnoses\Neoplasms (140-239)\Malignant neoplasms (140-208)\</item_key>
            <item_icon>FA</item_icon>
            <tooltip>Diagnoses \ Neoplasms \ Malignant neoplasms</tooltip>
            <class>ENC</class>
            <constrain_by_modifier>
                <modifier_name>No distant metastasis</modifier_name>
                <modifier_key>\\i2b2_DIAG\TNM\Metastisis\M0\</modifier_key>
                <applied_path>\i2b2\Diagnoses\Neoplasms (140-239)\Malignant neoplasms (140-208)\%</applied_path>
            </constrain_by_modifier>
            <item_is_synonym>false</item_is_synonym>
        </item>
        <item>
            <hlevel>3</hlevel>
            <item_name>Malignant neoplasms</item_name>
            <item_key>\\i2b2_DIAG\i2b2\Diagnoses\Neoplasms (140-239)\Malignant neoplasms (140-208)\</item_key>
            <item_icon>FA</item_icon>
            <tooltip>Diagnoses \ Neoplasms \ Malignant neoplasms</tooltip>
            <class>ENC</class>
            <constrain_by_modifier>
                <modifier_name>Cancer is localized</modifier_name>
                <modifier_key>\\i2b2_DIAG\TNM\Stage\I\</modifier_key>
                <applied_path>\i2b2\Diagnoses\Neoplasms (140-239)\Malignant neoplasms (140-208)\%</applied_path>
            </constrain_by_modifier>
            <item_is_synonym>false</item_is_synonym>
        </item>
    </panel>
</ns4:query_definition>

```

I want to find all instances of malignant neoplasms (cancerous tumors) where the presence or absence of distant metastasis is not specified, as well as cases where there are distant metastases (M1), no distant metastases (M0), or where the cancer is localized (Stage I).