```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>Malignant neoplasms@20:23:47</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) in the i2b2 database, regardless of the timing of diagnosis, with specificity set to 100, and constrained by the following modifiers: 
1. Distant metastasis cannot be evaluated
2. Distant metastasis is present
3. No distant metastasis
4. Cancer is localized.