Ultrasound-Guided Photodynamic Therapy With Photofrin & Gemcitabine for Patients With Locally Advanced Pancreatic Cancer

Inclusion Criteria:

* Unresectable, locally advanced measurable (at least bidirectional) adenocarcinoma of the pancreas (regardless of site) proven by biopsy or cytology and confirmed by surgical consultation
* Informed consent and authorization for the release of health information signed by the patient
* Karnofsky performance status \>= 70%
* Life expectancy \>= 3 months
* Females of childbearing potential and males must use an effective method of contraception

Exclusion Criteria:

* Metastatic (stage IV) disease (including involvement of the colon, adrenals, or kidney, or radiographic evidence of peritoneal seeding or pulmonary metastases)
* Previous chemotherapy, radiotherapy of other treatment for PC
* Gastric or duodenal wall invasion by the primary PC as assessed by CT or MRI and EUS staging
* Gastric or duodenal ulcer (at least 10 mm in size) within 10 mm of expected endoscopy puncture site(s) for PDT
* Esophageal or gastric varices
* Cystic component \>= 25% the total volume of the tumor
* Ascites detected by CT, ultrasound (US) or MRI; (trace ascites will not be an exclusion)
* Bulky celiac adenopathy (i.e., \>= 2.5 cm in diameter)
* Diagnosis of islet cell tumor, lymphoma, metastatic lesion, acinar cell (or other atypical pathologic malignancy)
* History of other malignancy in the past 2 years except carcinoma in situ of the cervix or bladder, non-melanomatous skin cancer or localized/early stage prostate cancer
* Unable to receive or previously intolerant of moderate and/or deep sedation
* Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) \>= 3 x upper limit of normal (ULN)
* Total bilirubin \>= 3 x ULN
* Alkaline phosphatase \>= 3 x ULN
* International normalized ratio (INR) \>= 1.5
* Partial thromboplastin time (PTT) ratio \>= 1.5
* Serum creatinine \>= 2.0 mg/dL
* Hematocrit =\< 28% or hemoglobin =\< 9 g/dL, but may have red blood cell (RBC) transfusion
* Platelet count =\< 100,000/microliter (uL)
* Absolute neutrophil count (ANC) =\< 1500/uL
* Clinically significant pancreatitis within 12 weeks of treatment with protocol therapy
* Contraindication to EUS-guided needle puncture into the pancreas
* History of coagulopathy or known thrombophilias
* Use of anticoagulants that cannot be discontinued both 5 days before and 5 days after EUS
* Clinical evidence of active infection of any type, including hepatitis B or C virus
* Pregnant or lactating women
* Experimental medications within the last 4 weeks prior to day 1
* Any surgery (including diagnostic laparoscopy and/or biliary +/- duodenal palliative bypass for inoperable PC) within the 2 weeks prior to day 1 of study protocol
* Chronic systemic corticosteroid use at superphysiologic doses (\>= 10 mg prednisone per day or equivalent)
* Inability to avoid exposure of skin or eyes to direct sunlight or bright indoor light for at least 30 days
* Porphyria
* Inability to obtain venous access in the antecubital region to administer PHO or sedation for endoscopy procedures
* Significant concurrent medical or psychiatric illness which, in the opinion of the principal investigator would interfere with trial participation