Upper abdominal cancers remain a significant challenge for radiation oncologists to treat. Many cancers in the upper abdominal tract are situated near critical structures with significant risk of toxicity for treatments that do not conform accurately to the target. Additionally the movement of structures in the abdomen can make accurate radiotherapy delivery more difficult to achieve. Finally cancers in the upper abdomen such as pancreatic cancer and gall bladder cancers are relatively radioresistant to conventional radiotherapy with photons. Potential benefits of charged particle therapies exist if the challenges of treatment delivery can be overcome. These aspects of treatment will be discussed in more detail.