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